外侧裂区脑挫裂伤79例临床分析

Clinical Analysis of Cerebral Contusion in Peri-Sylvian Fissure Area:79 Cases Report

目的总结外侧裂区脑挫裂伤的治疗经验及疗效。方法回顾性分析79例外侧裂区脑挫裂伤患者的临床资料,行双额冠状瓣开颅13例,单侧额颞大骨瓣开颅66例。24例单纯清除脑内血肿和挫伤脑组织,予硬膜修补;55例血肿清除后行硬膜成形和去骨瓣减压术,其中18例还加行额极和(/或)颞极切除内减压术。结果术后死亡15例,其中脑疝致中枢性衰竭9例,肺部感染2例,消化道出血2例,脑梗塞、脑干血管痉挛1例,晚期并发急性呼吸窘迫综合征1例。64例平均随访5个月(3个月～1年),根据GOS标准:良好44例,中残10例,重残7例,植物生存3例。结论采用标准外伤去大骨瓣减压手术治疗外侧裂区脑挫裂伤能提高手术疗效,术中应注意对外侧裂区血管的保护。

Objective To summarize the treatment experiences and effects of cerebral contusion in lateral fissure area. Methods The clinical data of 79 cases with cerebral peri-Sylvian contusion was analyzed retrospectively. The open craniotomy was performed via double frontal coronary fenestration in 13 patients and single frontal-temporal large craniotomy in 66 patients. The intraeranial hematoma removal and epidural repair was undertaken in 24 cases, and hematoma evacuation plus duraplasty and decompressive eraniectomy was performed in 55 cases. Results 15 patients were died, including 9 of central failure due to cerebral hernia, 2 of pulmonary infection, 2 of gastrointestinal hemorrhage, 1 of eerbral infarction and brainstem angiospasm and 1 of acute respiratory distress syndrome. 64 cases were followed up for 3 months to 1 year （5 months, averagely）. The outcomes showed good in 44 cases, moderate disability in 10, and severe disability in 7, and persistent vegetative status in 3 according to GOS Standard. Conclusion Large decompressive craniectomy can im- proved the surgical effect for treatment of cerebral peri-Sylvian contusion, but vessel protection of peri-Sylvian fissure must be pay more attention during the operation.