急性外伤性颅内血肿清除术后继发血肿再手术的原因分析

Analysis of Causes of Reoperation for Secondary Hematomas after Evacuation of Acute Traumatic Intracranial Hematomas

目的探讨急性外伤性颅内血肿清除术后再次手术的原因、预防及处理措施。方法2001年11月至2006年11月我科共对561例颅脑损伤病人急诊行开颅血肿清除术,术后31例发生迟发性血肿行再次手术治疗。结果本组31例再次手术后恢复良好7例,中残7例,重残8例,植物生存3例,死亡6例。结论急性外伤性颅内血肿清除术后继发血肿包括:①原血肿手术部位再出血;②多发性血肿的非手术部位血肿形成。临床应采取相应的有效预防措施,并强调严密观察病情变化、及时复查CT,以便及时发现并再次手术清除继发性血肿、缓解颅内压。

Objective To explore the causes, prevention and surgical treatment of secondary hematomas after evacuation of acute traumatic intracranial hematomas. Method The clinical data of 31 patients undergoing reoperation for secondary hematomas after evacuation of acute traumatic intracranial hematomas were analyzed retrospectively in 561 patients who underwent surgery for traumatic intracranial hematomas in recent 5 years. Results The incidence of secondary hematomas for which the reoperation was performed after evacuation of acute traumatic intracranial hematomas was 5.5%. Of the 31 patients who underwent reoperation, 7 recovered well, 7 were moderately disabled, 8 severely disabled, 3 vegetatively survived and 6 died. Conclusions After the evacuation of acute traumatic intracranial hematomas, the secondary hematomas which may be produced by varied causes are main causes of the reoperation. The effective measures directed at the causes of the secondary hematomas should be taken for a decrease in the reoperation in the patients after evacuation of acute traumatic intracranial hematomas. In the patients with acute traumatic intracranial hematomas the disease condition should be closely observed and cranial CT should be reexamined in time.