重型颅脑损伤开颅大骨瓣减压术后并发硬膜下积液的治疗和分析

Therapeutic strategy and analysis of subdural effusion after large decompressive craniotomies in patients with severe traumatic brain injury

目的探讨重型颅脑损伤开颅大骨瓣减压术后引起硬膜下积液的产生机制和治疗策略。方法回顾分析河北燕达医院神经外二科自2017年10月至2019年3月收治的15例去大骨瓣减压术后发生硬膜下积液患者的治疗过程及疗效。本组患者中,减压同侧硬膜下积液6例,减压对侧硬膜下积液4例,双侧硬膜下积液3例,合并纵裂镰旁积液2例,对各种硬膜下积液的不同治疗方法进行分析和总结。结果13例患者硬膜下积液消失,其中4例治愈出院,9例好转出院;1例患者硬膜下积液明显减少,好转出院,仍需长期观察;1例患者于外院行积液腔腹腔分流,硬膜下积液无明显减少,出现颅内感染,最终放弃治疗。结论开颅大骨瓣减压术后易导致的硬膜下积液,应结合病情采取不同治疗方法或联合应用来处理,才能提高疗效,改善患者生存质量。

Objective To investigate the generation and therapeutic strategy of subdural effusion after large decompressive craniotomies in patients with severe traumatic brain injury.Methods Retrospective analysis of the therapeutic process and results of 15 casas,from October 2017 to March2019,admitted by the second Department of Neurosurgery,Hebei Yanda Hospital,after large decompressive craniotomies treatment of subdural effusion.There were 6 cases of ipsilateral subdural effusion decompression,4 cases of contralateral subdural effusion decompression,3 cases of bilateral subdural effusion,and 2 cases of bilateral subdural effusion.The different treatment methods of subdural hydrops were analyzed and summarized.Results Thirteen cases of subdural effusion disappeared,of which 4 cases were cured and 9 cases were improved;1 case of subdural effusion was significantly reduced,improved and discharged,which still needs long-term observation;1 case of effusion cavity and abdominal shunt was performed in the external hospital,and the subdural effusion was not significantly reduced;intracranial infection occured,and treatment was finally abandoned.Conclusion According to different patient’s condition,the subdural fluid accumulation caused by craniotomy and large bone flap decompression should be treated with different therapeutic methods or comprehensive application could in order to further improve the effect of subdural effusion and life quality of the patients.