小儿后颅窝病变开颅术后枕部皮下积液的机制探讨及防治

PATHOLOGY AND TREATMENT OF OCCIPITAL SCALP HYDROPS AFTER POSTERIOR FOSSA CRANIOTOMY

目的分析小儿后颅窝开颅术后枕部皮下积液形成的原因，并探讨其防治措施。方法回顾性分析我院2010--2013年收治的12例儿童，年龄1～8岁，平均4．5岁，后颅窝开颅术后枕部皮下积液患者的临床资料。结果11例患儿治愈，1例患儿皮下积液合并脑积水迁延不愈，家属要求自动出院。其中6例经腰大池置管持续引流加枕颈部加压包扎治愈，5例经积液腔置管持续引流枕颈部加压包扎＋腰椎穿刺持续引流治愈，无一例再次打开切口手术处理。结论小儿枕颈部肌肉不发达，且术中硬膜、枕下肌肉层和皮下组织缝合不严密及局部遗留死腔是枕部皮下积液形成的主要原因，除传统腰大池置管持续引流外，积液腔置管持续引流枕颈部加压包扎效果肯定。

Objective To explore the mechanism, prevention and treatment of occipital scalp hydrops after posterior fossa craniotomy. Methods Data of 12 patients who had occipital scalp hydrops after posterior fossa craniotomy were retrospectively reviewed; whose clinical manifestations, laboratory ex- amination reports and treatments were analyzed. Results Eleven patients were cured,one patient who suffered from occipital scalp hydrops and hydrocephalus was discharged for poor prognosis without further treatment. Six cases of patients were treated with lumbar cistern drainage, pressure dressing on focal occipital regions, other five cases were performed with continuous drainage of occipital scalp hydrops, pressure dressing on focal occipital region and lumbar cistern drainage. No one case in our study required reoperation. Conclusion The main causes of occipitalia scalp hydrops includes imma- ture and underdeveloped muscles, not water - tight sewing of dura, suboceipital muscle layers and subcutaneous tissues or being left dead space in operation. Pressure dressing with continous drainage of hydrops cavity and lumbar cistern drainage are effective treatments on the complication.