人工异体皮在急性硬膜下血肿清除术中并发恶性脑膨出的临床应用

Clinical application of artificial allogeneic skin in malignant encephalocele during acute subdural hematomas

目的探讨人工异体皮在在急性硬膜下血肿清除术中并发恶性脑膨出的临床应用。方法收集自2011年6月至2013年6月收治的共37例急性硬膜下血肿术中出现恶性脑膨出患者的临床资料,将25例采用人工异体皮进行张力性缝合进行关颅患者纳入试验组,采用网状剪开硬脑膜强行关颅的12例患者作为对照组,所有患者均急诊行标准单侧或双侧去大骨瓣减压术。绘制Kaplan-Meier生存曲线,并采用log-rank检验对两组患者的生存曲线进行统计学分析。结果对照组患者中位生存时间为1.5d（1-5d）,试验组患者中位生存时间为（1-180 d）。log-rank检验提示试验组患者术后生存曲线与对照组比较,差异具有统计学意义（χ2=9.179,P=0.002）。结论急性硬膜下血肿清除术中并发恶性脑膨出的患者采用人工异体皮进行张力性缝合关颅,可在一定程度上提高患者的生存时间,改善预后。

Objective To investigate the clinical application of artificial allogeneic skin in patients with malignant encephaloeele during acute subdural hematomas. Methods The clinical data of 37 patients with malignant eneephalocele during acute subdural hematoma from June 2011 to June 2013 were divided into the treatment group （25 cases） and control group （12 cases）. Based on the standard large trauma eraniotomy or bilateral deeompressive craniotomy, patients in the treatment group were used artificial allogeneie skin to suture the crania, and patients in the control group were operated by dural netted incision decompression. Kaplan- Meier survival curves were drawn and the log-rank test was used to analyze and compared the Kaplan-Meier survival curves of the two groups. Results The median overall survival time was 1.5 d （1- 5 d）, and 5.5 d （1- 180 d）. for the control and treatment groups, respectively. The Kaplan-Meier survival curve showed that the control group had a lower survival rate than the treatment group. The log-rank test also showed significant differences of overall survival time between the treamtent and control groups （χ2 = 9.179, P= 0.002）. Conclusion The artificial allogeneic skin used to tension suture the crania can significantly improve the survival rate and prognosis of the patients with malignant encephalocele during acute subdural hematoma.