腰大池-腹腔分流治疗外伤性去骨瓣减压术后交通性皮瓣下积液

Lumboperitoneal shunt for the communicating fluid accumulation under skin flap after traumatic decompressive craniectomy

目的探讨去骨瓣减压术后交通性皮瓣下积液的治疗方法。方法回顾性分析13例颅脑损伤去骨瓣减压术后发生交通性皮瓣下积液病人的临床资料，采用腰大池-腹腔（lumboperitoneal，L—P）分流术。CT检查皮瓣下积液最大层面厚度为（38．52±6．09）mm。GCS评分（6．73±2．37）。结果术后13例病人皮瓣下积液最大层面厚度为（3．94±2．70）mm，小于分流前积液厚度（P〈0．05）；GCS评分（9．09±2．95），明显高于分流前评分（P〈0．05）。随访13例，时间1—12个月。11例意识障碍病人中。意识恢复正常3例，好转6例，无变化2例；7例瘫痪病人中，肌力明显提高4例，无变化3例；3例呕吐病人症状好转。术后无感染、出血等并发症。结论L—P分流治疗外伤性去骨瓣减压术后交通性皮瓣下积液疗效确切。

Objective To investigate the treatment method for communicating fluid accumulation under skin flap after decompressive craniectomy. Methods Clinical data of 13 traumatic brain injury patients with communicating fluid accumulation under skin flap after decompressive craniectomy were analyzed retrospectively. All the patients were treated with lumboperitoneal （L-P） shunt. The mean thickness of the accumulation under the flap of the maximum level was 38.52 ±6.09 mm. The mean GCS score was 6.73 ±2.37. Results After L-P shunt, the mean thickness of the accumulation under skin flap of the maximum level was 3.94 ±2.70 mm, which was smaller than that before shunt （P 〈 0.05）. The mean GCS score was 9.09 ±2.95, which was significantly higher than that before shunt （P 〈 0.05）. All the patients were followed up for 1 to 12 months. In 11 patients with conscious disturbance before operation, 3 recovered, 6 got better and 2 remained unchanged after operation. There were 7 patients with paralysis before operation, whose muscle strength improved in 4 patients and remained unchanged in 3 after operation. The symptom of vomiting improved in 3 patients after operation. There was no infection and bleeding after operation. Conclusion L-P shunt is effective for the communicating fluid accumulation under skin flap after traumatic decompressive craniectomy.