颅内静脉窦损伤30例手术治疗体会

Surgical treatment experience of 30 patients with intracranial venous sinus injury

目的分析颅内静脉窦损伤的临床特点,探讨急诊手术方法和技巧。方法回顾分析颅内静脉窦损伤患者30例,手术方式包括各种缝合、修补、悬吊、压迫、电凝、以及结扎等方法。结果上矢状窦损伤病例15例,横窦损伤病例10例,窦汇损伤病例5例,单处破口20例,多处破口10例。治愈18例(60.00%),其中静脉窦结扎术患者2例,硬脑膜瓣修补术患者6例,静脉窦破口间断缝合术患者3例,自体组织缝合悬吊固定术患者4例,单纯采用明胶海绵加湿棉片压迫处理3例;好转6例(20.00%),其中硬脑膜瓣修补术3例,静脉窦破口间断缝合术2例,自体组织缝合悬吊固定术1例,治疗总有效率为80.00%;无效4例(13.33%),其中硬脑膜瓣修补术2例,静脉窦裂口间断缝合术2例,转归为植物生存1例,中残1例,重残2例;死亡2例(6.67%),其中静脉窦破口间断缝合1例,自体组织缝合悬吊固定术1例,术后并发脑肿胀、多器官功能衰竭死亡。结论颅内静脉窦损伤是一种危急重症,手术难度较大,掌握一定的手术技巧,选择正确的治疗方案与止血方式,是提高手术成功率的关键。

Objective To analyze the clinical features of intracranial venous sinus injury and explore the emergency surgery methods and techniques. Methods Thirty patients with intracranial venous sinus injury were analyzed retrospectively and the surgical methods included suture,repair,suspension,oppression; electrocoagulation and ligation. Results There were 15 patients with superior sagittal sinus injury,10 patients with transverse sinus injury,5 patients with torcular injury,20 patients with single crevasse, 10 patients with multiple crevasses.Eighteen patients were cured （60.00%）,of which 2 patients received venous sinus ligation surgery,6 patients received endocranium valve repair surgery,3 patients received venous sinus crevasse interrupted suture surgery,4 patients received autologous tissue suture suspension fixation surgery,and 3 patients received simple gelatin sponge plus humidified cotton piece oppression treatment. Six patients（20.00%） improved,of which 3 patients received endocranium valve repair surgery,2 patients received venous sinus crevasse interrupted suture surgery,and 1 patient received autologous tissue suture suspension fixation surgery,with the total effective rate of 80.00%. Four patients （13.33%） were ineffective, of which 2 patients received endocranium valve repair surgery, 2 patients received venous sinus crevasse interrupted suture surgery,1 patient changed to vegetative state,1 patient had moderate disability, and 2 patients had severe disability. Two patients（6.67%） died from postoperative brain swelling and multiple organ failure,of which 1 patient received venous sinus crevasse interrupted suture surgery and 1 patient received autologous tissue suture suspension fixation surgery. Conclusion Intracranial venous sinus injury is a critical,acute and severe disease and has high surgical difficulty.Mastery of certain surgical skills and selection of right treatment schemes and hemostasis methods is the key to promoting surgical success rate.