大骨瓣减压术加内减压术治疗急性大面积脑梗死30例的临床经验总结

Clinical experience summary of 30 patients with acute massive cerebral infarction treated by large decompressive craniectomy plus internal de-compression

目的总结大骨瓣减压术加内减压术治疗急性大面积脑梗死的临床疗效及手术经验。方法选择2004年1月～2014年12月30例急性大面积脑梗死采用大骨瓣减压术加内减压术的患者进行回顾性分析，总结其愈后及手术经验。结果幕上行标准大骨瓣减压术（直径≥12cm）加内减压术治疗22例。幕下行大骨瓣减压术（直径≥4cm）加内减压术治疗8例。本组存活21例，死亡9例，存活率70．00％。存活患者随访3~6个月，按格拉斯哥预后评分（GOS），恢复良好7例，中度残疾8例，重度残疾4例，植物生存2例。结论大骨瓣减压术加内减压术能明显降低大面积脑梗死患者的死亡率。只要病情许可，尽可能早期手术干预，充分减压，才能最大限度挽救患者生命。

Objective To summarize the clinical efficacy and surgical experience of acute massive cerebral infarction treated by large decompressive craniectomy plus internal decompression. Methods Thirty patients with acute massive cerebral infarction who received large decompressive craniectomy plus internal decompression from January 2014 to December 2014, the prognosis and surgical experience were analyzed retrospectively. Results Twenty-two patients were given supratentorial standard large decompressive cranieetomy （diameter ≥ 12 cm） plus internal decompression. Eight patients were given subtentorial large decompressive craniectomy （diameter≥4 cm） plus internal decompression. In the group, 21 patients survived and 9 patients died, with the survival rate of 70.00%. The survived patients were followed up for 3 to 6 months, and according to the Glasgow Outcome Score （GOS）, 7 patients recovered well, 8 patients had moderate disability, 4 patients had severe disability and 2 patients were in a vegetative state. Conclusion Large de- compressive cranieetomy plus internal decompression can significantly reduce the mortality of patients with massive cerebral infarction. Early surgical intervention and full decompression should be performed to save the lives of patients to the maximum extent as long as the condition permits.