耳后弧形皮瓣治疗大脑半球大面积脑梗死(附28例分析)

Retroauricular arc-shaped skin flap for the treatment of massive cerebral infarction in the cerebral hemisphere:analysis of 28 cases

目的 探讨耳后弧形皮瓣治疗大脑半球大面积脑梗死的临床经验。方法 回顾性分析28例大脑半球大面积脑梗死患者病例资料,均为同一术者采用耳后弧形皮瓣进行减压治疗。统计患者切口愈合情况、手术时间、术后3个月存活率及颅骨修补情况。结果 26例切口愈合良好、2例糖尿病患者头皮切口愈合延迟。手术时间50~150min。术后3个月颅骨修补15例,其余患者无修补意愿。术后3个月随访,3例生活完全自理,12例家属帮助下生活基本自理,11例生活不能自理;死亡2例,病死率7.14%。结论 耳后弧形皮瓣操作简单,更有利于皮瓣血供保护,可作为大脑半球大面积脑梗死一种优先选择的手术方式。

Objective To explore the experience of using retroauricular arc-shaped skin flap to treat massive cerebral infarction in the cerebral hemisphere.Methods The clinical data of 28 patients with massive cerebral infarction,were analyzed retrospectively,all of whom were treated with the same surgeon using a retroauricular arc-shaped skin flap for decompressive craniectomy.The patients'incision healing,operation time,3-month postoperative survival rate and skull repair were recorded.Results Twenty-six incisions healed well,2 diabetic patients had delayed healing of scalp incisions.The operative time ranged from 50 to 150 minutes.Skull repair was performed in 15 patients within 3 months after surgery,while the remaining patients had no intention for repair.Follow-up at 3 months postoperatively revealed that 3 patients were fully self-sufficient in daily life,12 patients were partially self-sufficient with family assistance,and 11 patients were dependent on others for daily activities.Two patients died,resulting in a mortality rate of 7.14%.Conclusions The decompressive craniectomy with retroauricular arc-shaped skin flap is simple and more conducive to protecting the blood supply of the flap.It can be used as a preferred surgical method for massive cerebral infarction in the cerebral hemisphere.