微创技术在开颅术后矢状窦,横窦附近迟发性血肿的应用

Application of Minimally Invasive Operation in the Delayed Hematoma near to Sagittal Sinus and Transverse Sinus after Craniotomy

目的探讨微创手术方法治疗颅脑外伤行开颅术后矢状窦,横窦附近迟发性血肿的患者手术效果及远期疗效。方法选取本院2002年4月至2013年6月收治的颅脑外伤行开颅术后矢状窦,横窦附近迟发性血肿患者48例作为观察组,取1998年1月至2002年3月收治的开颅术后矢状窦,横窦附近迟发性血肿患者29例患者中26例行二次开颅手术患者为对照组。比较两组患者的手术效果及远期疗效。结果观察组患者的术后显效及总有效率（60.42%,95.83%）及远期疗效（78.76%）均显著高于对照组（34.62%,76.92%,42.31%）,差异均有统计学意义（P＜ 0.05）。29例中的3例保守治疗患者死于脑疝。结论颅脑外伤患者颅内血肿清除术后迟发硬膜外血肿,选择硬通道微创颅内血肿清除术的预后明显优于开颅手术。

Obj ective]To explore the outcome and long-term efficacy of minimally invasive operation for the treatment of patients with delayed hematoma near to sagittal sinus and transverse sinus after craniotomy.[Methods]A total of 48 patients with delayed hematoma near to sagittal sinus and transverse sinus after crani-otomy for craniocerebral trauma in our hospital from April 2002 to June 2013 were selected as observation group.Among 29 patients with delayed hematoma near to sagittal sinus and transverse sinus after craniotomy from Jan.1998 to March 2013,29 patients underwent second craniotomy,and 3 patients received expectant treatment.Surgical outcome and long-term efficacy of two groups were compared.[Results]The excellence rate,total effective rate and short-term efficacy in observation group were 60.42%,95.83% and 78.76%, which were obviously higher than those in control group（34.62%,76.92% and 42.31%）,and there were sig-nificant differences（P〈 0.05）.Three patients treated by conservative therapy died of cerebral hernia.[Con-clusion]Hard-tunnel minimally invasive evacuation of intracranial hematoma for the treatment of delayed epi-dural hematoma after evacuation of traumatic intracranial hematoma has better prognosis than craniotomy.