急性脑肿胀去骨瓣硬脑膜网状剪开减压31例

Effect of craniectomies and dural netted incision decompression swelling

目的探讨并比较治疗急性脑肿胀的手术方法和效果。方法将59例外伤性急性弥漫性脑肿胀患者随机分为手术组和常规手术组进行对比观察。手术组采用去骨瓣硬脑膜网状剪开减压术，常规手术组采用大骨瓣开颅，十字或星形或者弧形切开硬膜，去除血肿。结果手术组31例患者成活19例（61．3％），其中恢复良好11例（57．9％），中度残疾5例（26．3％），重度残疾2例（10．5％），植物生存1例（5．3％），死亡12例。常规手术组28例患者成活10例（35．7％），死亡18例（64．3％）；其中恢复良好5例（50．0％），中度残疾2例（20．0％），重度残疾2例（20．0％），植物生存1例（10．0％）。两组疗效比较差异有统计学意义（P〈0．05）。结论去骨瓣硬脑膜网状剪开减压术能有效缓解弥漫性颅内高压、保护中线结构，最大限度地保护脑组织的功能。

Objective To investigate and compare the therapeutic effects and methods for acute cerebral swelling. Methods Fifty-nine patients with acute cerebral swelling were randomly divided into operation group and routine operation group for comparative observation. Patients in operation group were operated by cranieetomies and dural netted incision decompression, patients in routine operation group were operated by large craniectomies, epidural hematoma was removed by cross or star shape or arc inci- sion. Results Nineteen cases （61.3%） in operation group survived; in which 11 cases （57.9%） re- covered, 5 cases （26.3%） were moderate disability, 2 cases （10. 5% ） were severe disability, 1 case （5.3%） was plant life, 12 cases（3~. 7% ） were death. Ten cases （35.7%） in routine operation group survived,18 cases （64. 3% ）were death, in which 5 cases （50. 0% ） recovered, 2 cases（20. 0% ） were moderate disability, 2 cases （20. 0% ） were severe disability, 1 case （10. 0% ） was plant life. The cura- tive effects of the two groups has significant differences （P 〈 0.05 ）. Conclusions Craniectomies and dural netted incision decompression can effectively relieve diffuse intracranial hypertension, protect midline structures, and protect the brain functions maximizely.