有占位效应的重型颅脑损伤术后再次手术去骨瓣减压41例分析

41 cases of re-operation using decompressive craniectomy after craniotomy in patients with traumatic mass lesions

目的总结重型颅脑损伤患者因占位性损伤术后再次手术去骨瓣减压的治疗经验。方法回顾性调查2008年1月～2014年10月在四川大学华西医院住院的重型颅脑损伤患者病历,筛查第一次手术清除脑挫裂伤或硬膜下血肿等占位性损伤术后保留骨瓣但再次手术去骨瓣减压的患者,分析再次手术去骨瓣减压原因。结果 41例术后再次手术去骨瓣减压,其中术后局部脑水肿和进展性出血34例,术区新发血肿6例,远隔部位血肿1例。结论有占位效应的重型颅脑损伤患者术后有14.4%的患者再次手术去骨瓣减压,对大多数没有术中脑膨出的患者保留骨瓣是安全的,但对于硬膜下血肿伴脑挫裂伤、伤后早期低血压和初始颅内压>35mm Hg的患者可能需要去骨瓣减压。

Objective To analyze the experience of re-operation using decompressive craniectomy(DC) to treat the patients with severe traumatic brain injury(sTBI) for mass lesions. Methods From Jan. 2008 to Oct.2014,the s TBI patients who underwent craniotomy for mass lesion evacuation in West China Hospital were retrospectively reviewed. The initial demographic and radiographic features were analyzed to identify risk factors of secondary DC requirement. Results There were 41 patients who underwent re-operation using DC,including 34 cases of regional edema and progressive traumatic hematoma,6 cases of focal neonatal hematoma and 1 case of remote site hematoma. Conclusion The incidence of re-operation using DC after craniotomy was 14. 4%. For most mass lesions patients without malignant brain swelling,craniotomy is an acceptable surgical method in primary intervention.For patients with subdural hematoma associated contusion,early hypotension and higher initial intracranial pressure(> 35 mm Hg),DC may be required.