额叶占位致脑中心疝64例诊治分析

Analysis of diagnosis and treatment of 64 patients with brain central hernia caused by occupying lesions in frontal lobe

目的探讨额叶占位所致脑中心疝的诊断、抢救与治疗。方法回顾性分析64例额叶占位病灶(肿瘤及脑挫裂伤、血肿等)所致脑中心疝患者的临床资料进。结果额叶占位致脑中心疝64例患者死亡22例,存活42例。存活者半年后按照GOS预后评分:3分4例,4分18例,5分20例。急性组脑中心疝患者术后死亡率45.45%;迟发组手术治疗死亡率14.29%,保守治疗死亡率57.14%。间脑期及期前死亡率为9.52%,较中脑-桥脑上部期(75%)、桥脑下部-延髓期(75%)、延髓期死亡率(100%)明显降低。结论额叶占位出现脑中心疝死亡率或病残率高,应严密观察病情变化,在间脑期及之前及时、果断手术可以明显改善预后,降低病残率和病死率。

Objective To investigate the diagnosis,rescue and treatments of brain central hernia caused by occupying lesions in frontal lobe. Methods The clinical data of 64 patients with brain central hernia caused by occupying lesions in frontal lobe such as tumors, cerebral contusion, and hematoma were retrospectively analyzed. Results Of the 64 cases ,42 survived and 22 died. The 42 sur- vivors were evaluated for 12 months after half year according to GOS standard, in which 4 were scored as 3 points, 18 were scored as 4 points and 20 were scored as 5 points. Postoperative mortality in patients with brain central hernia in the acute group was 45.45%, in the late group was 14. 29% , and in the conservative group was 57. 14% , respectively. The mortality of patients before and during the di- encephalon period was 9. 52% while the mortality was 75% in the stage of midbrain-upperpons ,75% in the stage of lowerpons-medul- la, and 100% in the stage of medulla. Conclusion The mortality and morbidity in patients with cerebral central hernia caused by occu- pying lesions in frontal lobe are high. We should pay more attentions to it. Operation in time for patients before and during the dienceph- alon period can significantly improve the prognosis, and subsequently reduce the mortality and morbidity of the patients.