外伤性小脑血肿的手术治疗

Surgical Treatment for Traumatic Intracerebellar Hematoma

目的探讨外伤性小脑血肿的手术指征和手术技术。方法回顾性分析手术治疗20例外伤性小脑血肿的临床资料,脑室外引流术+小骨窗开颅血肿清除术12例,小骨窗开颅血肿清除术5例,脑室外引流术3例。采用日常生活能力评分(ADL)判断手术效果。结果死亡3例,其中1例死于枕骨大孔疝所致中枢性呼吸循环衰竭,1例死于术后再出血,1例术后第4周死于持续昏迷肺部感染。手术后随访6个月,存活者按ADL判定疗效:Ⅰ级5例,Ⅱ级7例,Ⅲ级3例,Ⅳ级1例,Ⅴ级1例。结论根据外伤性小脑血肿的出血量、出血部位、血肿是否破入脑室等情况,选择适当病例,尽早进行血肿清除术和/或脑室外引流术,可取得良好的疗效。

Objective To explore the operative indications of traumatic intracerebellar hematoma and the operation technique. Methods A retrospective analysis was made to the clinical data of surgical treatment in 20 cases with traumatic intracerebellar hematoma, including external ventricular drainage combined with small bone window hematoma evacuation in 12 cases, small bone window craniotomy for evacuation hematomas in 5 cases and external ventricular drainage in 3 cases ; the surgical effect was evaluated by Activity of Daily Living （ADL） scores. Results 3 cases died ： 1 died of central respiratory and circulatory failure due to tonsillar hernia, 1 died of recurrent hemorrhage and 1 died of pulmonary infection with persistent coma 4 weeks after surgery ; follow - up lasted for 6 months ; the curative effect in the survivals was assessed with the scores ： 5 cases of grade Ⅰ, 7 cases of grade Ⅱ, 3 cases of grade Ⅲ, 1 case of grade Ⅳ and 1 case of grad Ⅴ. Conclusions Good curative effect can be achieved in adapting cases with traumatic intracere- bellar hematoma through early evacuation and/or ventricle drainage according to the bleeding volume, the bleeding site and the hematoma broken into the ventricle or not.