个体化治疗颅骨缺损合并硬膜下或皮瓣下积液的临床观察

Clinical observation of indivi dualized treatment of slcull defect with subdural or flap effusion

目的:探讨不同类型颅骨缺损合并硬膜下或皮瓣下积液的治疗方法。方法:选取2012年8月~2016年6月40例去骨瓣减压术后颅脑缺损合并硬膜下或皮瓣下积液患者。消退型23例,直接行颅骨修补术;稳定型15例,其中7例行积液腔包膜切除联合颅骨修补术治疗,8例先行加压包扎,随后实施颅骨修补术治疗;合并型2例,实施脑室腹腔分流后,择期开展颅骨修补术治疗。回顾性分析患者的临床效果。结果:22例消退型患者在1~2个月的随访中积液消失,1例患者术后积液增加,通过保守治疗4个月后自行吸收;7例行积液腔包膜切除联合颅骨修补术患者,术后复查积液均少于术前,或彻底消失,残留少量积液患者经随访积液亦彻底消失;8例加压包扎后颅骨修补患者术后积液没有明显增加,观察随访6个月后自行吸收;2例合并型经过脑室腹腔分流术联合颅骨修补术后积液彻底消失,效果较明显。结论:颅骨缺损伴硬膜下或皮瓣下积液采用手术治疗的临床效果较好,加压包扎联合颅骨修补术对硬膜下积液有显著的治疗效果。

Objective To explore the treatment of skull defect with subdural or flap effusion.Method From August 2012 to June 2016,40 patients with cranial defect complicated with subdural or flap effusion after brain surgery were operated in our hospital.23 patients with receding type underwent direct skull repair,7 patients with stable type underwent hydropic cavity capsule resection combined with skull repair,8 patients underwent skull repair after pressure bandaging,and 2 patients with combined type underwent skull repair after ventriculoperitoneal shunt.The clinical effect of the patients was analyzed.Results The majority of patients with regression type were followed up for 1~2 months.In one case,the effusion was more than that before operation,which was absorbed by conservative treatment 4 months later.In the treatment of stable hydroceliectomy combined with cranioplasty,the postoperative fluid accumulation was less than that before operation.There was no significant increase in postoperative effusion in patients with cranial bone repair after compression bandaging,and after follow-up for more than 6 months,the hydrops were absorbed by themselves.In the combined group,the effusion disappeared completely after ventriculoperitoneal shunt,and the effect of skull repair was obvious.Conclusion The clinical effect of surgical treatment for chronic effusion is good,and the combination of compression bandaging and skull repair is effective in the treatment of subdural or flap effusion.Lower effusion has remarkable therapeutic effect.