显微外科手术治疗复杂性脑挫裂伤

Microsurgery in the treatment of complex cerebral contusion and laceration

目的分析显微外科手术治疗复杂性脑挫裂伤的手术经验及疗效。方法回顾性分析联勤保障部队第九〇〇医院神经外科自2018年1月至2020年12月收治的45例接受显微镜下复杂性脑挫裂伤清除术患者的临床资料。结果单侧开颅清除单侧脑挫裂伤者27例,双侧开颅清除双侧脑挫裂伤者11例,单侧开颅行双侧额叶脑挫裂伤清除术者4例,双侧脑挫裂伤行单侧脑挫裂伤清除术者3例。血肿完全清除者18例,少量残留者17例,部分残留者10例。术后血肿再发1例,死亡1例。随访3~6个月后,GOS评分恢复良好者26例,中等残疾者8例,重度残疾者6例,植物状态者4例。结论显微手术有助于彻底清除血肿,充分减压,并减少不必要的损伤,降低术后并发症风险。

Objective To analyze and summarize the experience and curative effect of microsurgery in the treatment of complex cerebral contusion and laceration.Methods The clinical data of 45 patients with complex cerebral contusion and laceration who underwent microsurgery in Neurosurgery Department of 900th Hospital of Joint Service Support Force from January 2018 to December 2020 were retrospectively analyzed.Results Unilateral craniotomy for unilateral contusion and laceration in 27 cases,bilateral craniotomy for bilateral contusion and laceration in 11 cases,unilateral craniotomy for bilateral frontal lobe contusion and laceration in 4 cases,and 3 cases with bilateral contusion were treated with unilateral evacuation of hematoma.The hematoma was completely removed in 18 cases,a small amount remained in 17 cases,and a partial residual in 10 cases.Postoperative hematoma recurred in 1 case and died in 1 case.After 3-6 months of follow-up,it is found that 26 cases recovered well with good GOS score,8 cases had moderate disability,6 cases had severe disability and 4 cases with vegetative state.Conclusion Microsurgery helps surgeon to completely remove the hematoma,adequately decompress intracranial pressure,reduce unnecessary iatrogenic injury,and reduce the risk of postoperative complications.