急性外伤性颅内血肿清除术后再发血肿的CT表现

CT images of recurrent hematoma after evacuation of acute traumatic intracranial hematoma

目的探讨外伤性颅内血肿清除术后再发血肿(即迟发血肿)的临床CT表现及相关因素。方法以43例外伤性颅内血肿清除术后再发血肿的患者为观察组,选择同时期外伤性颅内血肿清除术后无再发血肿的病例50例为对照组。分析迟发血肿的CT表现,并将两组病例术前CT片中除颅内血肿外的其它外伤性CT表现进行对比分析。结果再发血肿有:硬膜外血肿17例、硬膜下血肿6例、脑内血肿13例、混合性血肿7例;观察组术前其它外伤性CT表现有:多发性脑挫伤33例、广泛蛛网膜下腔出血23例、基底池受压或闭塞32例、多发颅骨折21例、中线结构移位>1cm19例;与对照组比较上述前3种CT表现病例数差异有显著性意义(P<0.05);上述术前5种其它外伤性CT征象在观察组每一病例中至少有两种以上征象合并存在,与对照组比较差异有显著性意义(P<0.05)。结论CT检查是发现和评价外伤性颅内血肿清除术后再发血肿的重要方法,对术后可能发生再发血肿有重要的提示作用。

Objective To discuss CT manifestations and relative factors of recurrent hematoma, ie, delayed intracranial hematomas （DICH） after evacuation of traumatic intracranlal hematomas （ TICH ）, Methods Forty-three patients with recurrent hematoma after evacuation of TICH were selected to investigation group and 50 patients without DICH after operation of TICH in the same period were selected to control group, CT manifestations of DICH in TICH were analyzed and CT manifestations of other traumatic injuries before operation were compared between the two groups. Results DICH included four main types： epidural hematoma （n = 17）, subdural hematoma （n =6）, intracerebral hematoma （n = 13）, and mixed hematoma （n =7）. In investigation group, the case number implicated in such CT manifestations as serious cerebral contusion, extensive subarachnoid hemorrhage, basilar cistern compression or obstruction before operation was significant different as compared with the control group （ P 〈 0.05 }. The coexistent CT features of craniocerebral injuries in DICH group were significantly higher than those of control group （P 〈0.05）. Conclusion CT examination is an effective method to find and evaluate DICH after evacuation of TICH. We deem that analysing meticulously the CT features of each case of TICH before operation is mandatory to secure an early detection of DICH.