颅脑肿瘤术后远隔部位急性硬脑膜外血肿的原因及预防

The reason and prevention of postoperative acute epidural hematoma remote from the site of craniotomy

目的浅析颅脑肿瘤术后远隔部位急性硬脑膜外血肿形成的原因，总结其预防措施和治疗方法。方法回顾性分析14例颅脑肿瘤术后远隔部位急性硬脑膜外血肿发生的特点，对临床资料进行总结剖析。结果14例患者，血肿出现在幕上10例，幕下l例，幕上下3例，血肿量35～120（48．7±3．6）ml；均行急诊开颅血肿清除术，13例痊愈，1例病情加重而自动出院；最快术后30min，最迟术后46hCT确诊后急诊手术。结论颅脑肿瘤术后远隔部位急性硬脑膜外血肿形成机制为多种原因导致的颅内压及脑脊液动力学改变致硬脑膜与颅骨剥离；为减少此类并发症，在术前、术中及术后须对诸多因素加以防范，术后严密监护，必要时复查头颅CT做出早期诊断，手术治疗是避免病情恶化的关键。

Objective To analyze the reason of postoperative acute epidural hematoma remote from the site of craniotomy and to summarize its prevention measures and treatment methods. Methods Retrospectively analyzed the characteristic of 14 eases of postoperative acute epidural hematoma remote from the site of craniotomy, a summarized analysis of clinical data was made. Results In the 14 cases of hematoma,there were 10 cases of supratentorial hematoma, I case of infratentorial hematoma and 3 cases of supratentorial and infratentorial joint hematoma. The average hematoma quantity was 35 - 120 （48.7 ＋ 3.6） ml. All cases underwent emergency hematoma evacuation and 13 cases were cured, 1 case was deteriorated and automatically discharged. The shortest time of confirming postoperative acute epidural hematoma by CT scan was 30 minutes, and the longest time was 46 hours. Conclusions The formation mechanism of postoperative acute epidural hematoma remote from the site of craniotomy is the dural stripping from the skull caused by changes of intracranial pressure and cerebrospinal fluid dynamics, which are induced by a variety of reasons. In order to reduce such complications, many factors are required to be noted during perioperative period. Intensive care is needed after operation and a head CT for early diagnosis and surgical treatment is the key to avoiding disease progression.