单双开颅手术治疗双额叶脑挫伤的效果比较

Comparison between effects of unilateral and bilateral craniotomy in treatment of bilateral frontal lobe brain contusion

目的比较单侧额颞瓣开颅＋大脑镰切开与双侧额颞瓣开颅对清除双侧额叶脑挫伤的手术疗效。方法对我科2010年1月-2013年1月行手术治疗的双额叶脑挫伤53例进行回顾性分析,根据手术方式将患者分为两组,其中A组25例,行单侧开颅＋大脑镰切开术;B组28例,行双侧额颞瓣开颅。结果术中均直视下清除双侧额叶脑内血肿及挫伤坏死脑组织,术后CT检查提示脑挫伤血肿清除满意。A组平均手术时间、输血量均少于B组患者（P〈0.05）。出院3个月后随访,两组在良好率、中残率及病死率方面无明显差异（P〉0.05）,但A组重残率明显低于B组（P〈0.05）。结论单侧额颞瓣开颅＋大脑镰下切开清除双侧额叶挫裂伤具有创伤小、手术时间短、失血少、患者预后好的优点。

Objective To compare the effects of unilateral frontotemporal craniotomy ＋ cerebral falx incision and bilateral frontotemporal craniotomy in treatment of bilateral frontal lobe brain contusion. Methods Retrospective analysis was made for 53 patients with bilateral frontal lobe brain contusion to receive operation treatment in our department from Jan. 2010 to Jan. 2013.According to the operation mode,they were divided into two groups. Group A（ n = 25） was provided with unilateral frontotemporal craniotomy ＋ cerebral falx incision and group B（ n = 28） was provided with bilateral frontotemporal craniotomy. Results During the operation,bilateral frontal cerebral hematoma and brain contusion and necrosis tissue were eliminated under direct vision; the CT examination after operation suggested that the treatment of the cerebral hematoma and brain contusion was satisfactory. Both the average operation time and blood transfusion amount in group A were lower than those in group B（ P〈 0. 05）. According to the three-month follow-up,the goodness,moderate disability rate and fatality rate between the two groups had no significant differences（ P〉 0. 05）,but the severe disability rate in group A was much lower than that in group B（ P〈 0. 05）. Conclusion In comparison with bilateral frontotemporal craniotomy,unilateral frontotemporal craniotomy ＋ cerebral falx incision applied to elimination of bilateral frontal lobe brain contusion has more advantages including less trauma,shorter operation time,less blood loss,and better prognosis.