颅脑损伤单侧去骨瓣减压术后对侧硬膜下积液43例治疗分析

Retrospective analysis of 43 cases of contralateral traumatic subdural hygromas after one side hemicraniectomy

摘要:

目的 探讨颅脑损伤单侧去骨瓣减压术后对侧硬膜下积液的临床治疗策略。方法 回顾分析我科2008年1月到2011年12月单侧去骨瓣减压术后对侧外伤性硬膜下积液43例临床资料，全部病例均先行保守治疗，最终19例进行了手术治疗。结果 术后随访6个月，4例转变为慢性硬膜下血肿最终行钻孔引流术，15例均先行硬膜下积液腔钻孔外引流联合腰大池穿刺置管持续引流治疗，其中10例治愈，5例迁延不愈后均再行积液腔-腹腔分流术，4例治愈，1例堵管，堵管者又开颅清除包膜使包膜腔与蛛网膜下腔交通后治愈。非手术治疗者治愈率为55.8%。结论 外伤性硬膜下积液大部分能通过保守治疗治愈，无手术指征者，保守治疗，效果满意，但需定期随诊，警惕其转变为慢性硬膜下血肿；有手术指征者一般先行单纯钻孔引流术，如迁延不愈可再行积液腔-腹腔分流术以及开颅清除包膜使包膜腔与蛛网膜下腔交通以达治愈目的。

Abstract:

Objective To evaluate the methods and effects of clinical treatment strategies of 43 cases of contralateral traumatic subdural hygromas after one side hemicraniectomy. Methods We retrospectively analyzed 43 cases of clinical data. All the patients were treated by conservational treatment.Among of them,19 cases were treated by surgical treatments at last.Results Among of these 19 cases,4 cases were evolved into chronic subdural hematomas finally.In 15 cases treated by surgical treatments,subdural hygromas disappeared totally in 10 cases treated by subdural external drainage. 5 cases were unchanged and then they were treated by subdural to peritoneal shunt.Whereas one patient were treated by sylvian arachnoid ostomy via pterional keyhole approach because of shunt blockage.Conservational treatments cure rate was 55.8%. Conclusions The patients of traumatic subdural hygromas should be treated by conservational treatments first.Surgical treatments including subdural external drainage,subdural to peritoneal shunt and sylvian arachnoid ostomy via pterional keyhole approach are safe and effective ways for traumatic subdural hygromas.