颅脑创伤后反复严重鼻出血13例诊疗分析

Clinical analysis on recurred and serious epistax after craniocerebral trauma （ report of 13 cases）

目的 探讨颅脑创伤后反复严重鼻出血的病因、临床诊治与疗效。方法回顾性分析13例颅脑创伤后反复严重鼻出血患者的诊治经过，所有患者均行全脑血管造影检查，7例为上颌内动脉蝶腭支假性动脉瘤，3例用明胶海绵颗粒栓塞，4例用弹簧圈栓塞，其中1例合并同侧大脑前动脉A2段假性动脉瘤；4例为颈内动脉海绵窦瘘合并假性动脉瘤，可脱球囊栓塞；2例为颈内动脉海绵窦瘘，1例可脱球囊栓塞，1例可脱球囊结合弹簧圈栓塞。结果13例患者预后良好，2例出现一过性并发症，1例出现永久并发症，随诊1～7年未再出现鼻腔出血。结论 颅脑创伤后反复严重鼻出血患者多有颈内动脉、颈外动脉本身或其分支的损伤，保守治疗无效，应尽早行全脑血管造影明确诊断，介入栓塞为安全有效的治疗方法。

Objective To introduce an effective treatment for postoperative contralateral subdural effusion of traumatic brain injury patients after decompressive craniectomy. Methods 13 cases of traumatic brain injury with contralateral subdural effusion after decompressive eraniectomy were treated with lumbar puncture or effusion hole drainage but failed, then early cranioplasty was performed. Results The subdural effusion in 13 patients were completely disappeared or reduced in the postoperative half months. Conclusions Early cranioplasty was an effective treatment for traumatic brain injury patients with contralateral subdural effusion after decompressive craniectomy.