双额叶重度脑挫裂伤并发中央型脑疝的手术治疗

Surgical Treatment for Severe Bilateral Frontal Brain Contusion Complicated by Central Herniation

目的探讨双额叶重度脑挫裂伤并发中央型脑疝的手术治疗。方法选择该院2008年1月—2013年1月收治的经CT确诊为双额叶重度脑挫裂伤并发中央型脑疝患者32例,根据患者的CT结果及临床表现,应用单侧去骨瓣减压术或双侧去骨瓣减压术治疗,对手术结果进行总结分析。结果术后随访1年后结果显示,32例患者中存活28例,死亡4例,死亡率为12.5%;其中单侧去骨瓣减压术死亡1例,双侧去骨瓣减压术死亡1例,呼吸衰竭死亡1例,多器官衰竭死亡1例。根据GCS评分评价治疗效果,结果显示:良好12例(37.5%),轻残11例(34.38%),重残3例(9.38%),植物生存2例(6.25%),死亡4例(12.5%)。结论双侧额叶重度脑挫伤患者往往临床表现比较隐匿,病情进展快,应及时根据手术指征采取手术治疗,可有效改善患者预后。

Objective To investigate the surgical treatment for severe bilateral frontal brain contusion complicated by central herniation. Methods 32 patients diagnosed as severe bilateral frontal brain contusion complicated with central herniation by CT in our hospital from January 2008 to January 2013 were selected. According to the results of CT and clinical manifestations, the patients were treated with unilateral decompressive craniectomy or bilateral decompressive craniectomy, and the surgical results were summarized and analyzed. Results The result of postoperative 1-year follow-up showed that of the 32 cases, 28 cases survived, 4 cases died, including 1 case died of unilateral decompressive craniectomy, 1 case died of bilateral decompressive craniectomy, 1 case died of respiratory failure, and 1 case died of multi-organ failure, the mortality rate was 12.5%. The therapeutic effect was evaluated by GCS score, the results showed that good in 12 cases（37.5%）, mild disability in 11 cases（34.38%）, severe disability in 3cases（9.38%）, plant survival in 2 cases（6.25%）, 4 cases of death（12.5%）. Conclusion The clinical manifestations of severe bilateral frontal brain contusion are often dormant, and the disease progresses rapidly, timely surgical treatment based on the surgical indications can effectively improve the prognosis of the patients.