双额大骨瓣与双侧标准大骨瓣治疗外伤性急性弥漫性脑肿胀的疗效比较(1)
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【摘要】 目的 对比观察双额大骨瓣开颅术与双侧标准大骨瓣开颅术治疗外伤性急性双侧弥漫性脑水肿、脑肿胀合并难治性颅高压的疗效。
方法 2008年8月～2011年1月收治的17例患者采取双额大骨瓣开颅手术(A组)，2006年6月～2008年8月收治的31例患者采取双侧标准大骨瓣开颅手术(B组)。观察两组手术时间、失血量、减压窗面积、术中脑膨出率、术后基底池评分、术后并发症发生率及6个月后GOS评估预后。结果 A组术中出血量少于B组，手术时间短于B组,骨窗面积大于B组，差异有统计学意义(P<0.01)，术后基底池评分、术中脑膨出率、术后并发症发生率及预后等比较差异无统计学意义(P>0.05)。结论 双额大骨瓣与双侧标准大骨瓣对外伤性急性弥漫性脑肿胀的救治效果相当，但双额大骨瓣创伤小、开颅快速，能有效降低颅内压，值得临床推广。
【关键词】 双额大骨瓣；双侧标准大骨瓣；平衡减压；弥漫性脑肿胀
文章编号：1003-1383(2011)06-0694-03 中图分类号：R 651.1+5 文献标识码：A
doi:10.3969/j.issn.1003-1383.2011.06.003
The comparison of efficacy of the bifrontal big bone craniectomy and the bilateral standard big bone craniectomy in the treatment of posttraumatic acute diffuse encephaledema
CUI Yonghua1、2,XIA Yongben2,ZHANG Liyong2,CHEN Henglin2,HAN Qing2,YU Rutong3
(1.Graduate Faculty, Xuzhou Medical College, Xuzhou, Jiangsu 221002；2.Neurosurgery
Department, Jianhu People's Hospital, Jianhu County, Jiangsu 224700；3.Neurosurgery Department,Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221002)
【Abstract】 Objective To investigate the efficacy of bifrontal big bone craniectomy and bilateral standard big bone craniectomy in bilateral posttraumatic acute diffuse encephaledema and refractory intracranial hypertension with brain swelling merger.
Methods There were two groups: Group A included 17 cases treated by bifrontal big bone craniectomy from August of 2008 to January of 2011 and Group B included 31 cases treated by bilateral standard big bone craniectomy from June of 2006 to August of 2008. The operative duration, blood loss, postoperative reduced pressure window area, intraoperative encephalocele rates, rates of postoperative complications, postoperative basal cistern scores and the GOS evaluation prognosis 6 months after operation of the two groups were recorded and compared.
Results Blood loss of Group A was less than that of Group B. The surgical time of Group A was shorter than that of Group B. And the bone window area of Group A was larger than that of Group B. The differences were statistically significant. Differences of intraoperative encephalocele, postoperative basal cistern scores, rates of postoperative complications and prognosis were statistically significant ......
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