颅内血肿清除术后继发血肿再次手术的原因分析

Intracranial hematomas removal surgery secondary again the cause analysis of the hematoma surgery

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:2008年3月至2009年3月我科共对70例颅脑损伤病人急诊行开颅血肿清除术,术后6例发生迟发性血肿行再次手术治疗。结果:本组6例再次手术后恢复良好2例,中残1例,重残1例,植物生存1例,死亡1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.Methods：The clinical data of 6 patients undergoing reoperation for secondary hematomas after evacuation of acute traumatic intracranial hematomas were analyzed retrospectively in 70 patients who underwent surgery for traumatic intracranial hematomas in recent yeas.Results：The incidence of secondary hematomas for which the reoperation was performed after evacuation of acute traumatic intracranial hematomas was 8.5%.Of the 6 patients who underwent reoperation,2 recovered well,1 were moderately disabled,1 severely disabled,1 vegetatively survived and 1 died.Conclusion：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.