重度颅脑损伤致脑中心疝的外科治疗

The surgical treatment of brain centre hernia caused by severe brain injury

目的探讨双额叶脑挫裂伤并发生脑中心疝诊断及治疗方法,以利于提高重度颅脑损伤的治疗效果。方法病例选自2008年6月至2013年6月河北大学附属医院神经外科,双额颞脑挫裂伤并发脑中心疝患者126例。全组病人采取包括手术在内的综合治疗,手术采取双侧去颅骨骨瓣减压术及内减压。间脑期手术63例,生存54例,非间脑期手术49例,生存例36;手术112例,生存93例,保守治疗14例,存活2例;进行病例分析,探讨脑中心疝的诊断及治疗。结果手术治疗组的生存率高于保守治疗组,差异有统计学意义(P<0.05)。脑中心疝间脑期手术治疗组的生存率高于非间脑期手术治疗组,差异有统计学意义(P<0.05)。结论要高度重视脑中心疝诊疗,加强间脑期的监护,可取得较好的治疗效果。

Objective To analyze and discuss the diagnosis and treatment of bilateral frontal brain contusion with cerebral centre hernia in order to improve the curative effect of severe brain injury .Methods The 126 patients suffering from bilateral frontotemporal brain contusion with cerebral centre hernia were enrolled in .They were admitted in the department of neurosurgery in the affiliated hospital of Hebei University from June 2008 to June 2013.All patients were given comprehensive treatment including surgery . The surgical procedure included bilateral decompressive craniectomy skull and internal decompression surgery .Among all the cases , 63 cases surgery during diencephalon period , 54 cases survived; 49 cases surgery during nondiencephalon period, 36cases survived .112 cases were performed surgery , of which 93 survived; while 14 cases received conservative treatment , 2 cases survived.We explored the diagnosis and treatment of cerebral centre hernia in the method of retrospect review Results The survival rate of surgical treatment group was higher than that of the combining with relevant literatures . conservative treatment group , the difference was statistically significant （ p〈0.05） .The survival rate of the diencephalon period of brain centre hernia surgery group was higher than that of nondiencephalon period surgery group , the difference was statistically significant （ p〈0.05） Conclusion The patient with brain centre hernia should be paid more attention to , the importance of early diagnosis should be clearly elucidated and the monitoring of patient during diencephalon period should be reinforced .So undergoing surgery during diencephalon period may achieve better therapeutic effect .