外侧裂区脑挫裂伤的显微手术治疗策略

Microsurgery strategies for contusion and laceration around lateral fissure

目的探讨外侧裂区脑挫裂伤的显微手术处理策略、技巧,以及对预后的影响。方法回顾性分析90例外侧裂区脑挫裂伤患者的临床资料、手术步骤及术后6个月的随访结果。用格拉斯哥预后量表(Glasgow outcome scale,GOS)评分评判患者的预后;Evans指数评定脑积水的发生。结果本组患者中,术后GOS评分为良好者53例、中残16例、重残9例、植物生存5例、死亡7例;术后发生脑积水者仅2例。结论显微镜下优化手术策略及步骤:“内、外”减压相结合、保护侧裂血管、减少血性脑脊液(减少脑积水),可改善外侧裂区脑挫裂伤的手术治疗效果。

Objective To explore the microsurgical management strategies and techniques of contusion and laceration of the lateral fissure area,and its impact on prognosis.Methods The clinical data of 90 patients with lateral fissure contusion and laceration were analyzed retrospectively and followed up for 6 month,assessed the effect by GOS,the occurrence of hydrocephalus was counted by Evans index.Results According to GOS,53 cases were good,16 moderately disabled,9 severely disabled,5 vegetative survival,and 7 were dead.Of 90 patients,only 2 got postoperative hydrocephalus.Conclusion The patients can achieve better results and lower incidence of hydrocephalus with microscopic assisted and optimization of operation strategies and steps such as decompression of“internal and external”,protection of the blood vessels of lateral fissure and reduction of bloody cerebrospinal fluid.