颅内肿瘤开颅术中继发颅内出血原因分析

Analysis of cause of Secondary intracranial hemorrhage during craniotomy for intracranial tumor

目的 探讨颅内肿瘤开颅术中继发颅内出血的原因及其处理对策.方法 回顾性分析15例因颅内肿瘤行开颅手术治疗且术中继发颅内出血患者的临床资料,对肿瘤特征及经再次手术确证的出血责任血管等情况进行总结.结果 15例患者病程较长,为6.5个月至2年,平均1.2年,颅内肿瘤体积均较大,直径4.62～5.82 cm,平均5.12 cm,肿瘤位置均较深,瘤周水肿涉及范围大,颅内压高.所有病例均行二次手术治疗,术中确证责任血管为导静脉、桥静脉及皮层引流静脉.无死亡病例,随访3个月,生活均可自理.结论 颅内肿瘤术中继发颅内出血与术中颅内压骤降及局部血管再灌注突破有关.准确判断术中继发颅内出血的发生及迅速采取有效的应对措施是改善该类患者预后的重要策略.

Objective To explore the reasons and the treatment counter-measures for secondary intracranial hemorrhage happens in the intracranial tumor craniotomy. Methods Retrospectively analyzed the clinical data of 15 patients with intracranial tumor who suffered secondary intracranial hemorrhage intraoperation. Summarized the tumor characteristics and the situation of corresponding vessels confined by second operation. Results In these 15 cases,the rank of course of disease was 6.5 months to 2 years, mean 1.2 years. The size of the tumor was big with diameter 4.62 ～5. 82cm,mean 5. 12cm,and the tumor was deep surrounding by large range edema,which led to intracranial hypertension. The emissary vein,bridging vein and cortical draining vein were considered as the corresponding vessels for ＇ secondary intracranial hemorrhage during the second operation carried out for all 15 cases. There wsa no death cases in this research and all patients recovered the nomal ability for self-caring after 3 months following up. Conclusion Sudden drawdown of intracranial pressure and perfusion pressure breakthrough of local vessels had relationship with secondary intracranial hemorrhage during craniotomy for intracranial tumor. Accurate judgement for the occurrence of secondary intracranial hemorrhage intra-operation and quickly taking the effective corresponding measures was the important strategy for prognosis improving for these patients.