上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (8): 1075-.doi: 10.3969/j.issn.1674-8115.2012.08.024

• 论著（临床研究） • 上一篇    下一篇

58例横窦骑跨性硬膜外血肿的微创手术治疗

陆兆丰1, 邱永明2, 程小兵1, 孟晓峰1   

  1. 1.河南科技大学第一附属医院神经外科, 洛阳 471001；2.上海交通大学 医学院附属仁济医院神经外科, 上海 200001
  • 出版日期:2012-08-28 发布日期:2012-08-29
  • 作者简介:陆兆丰（1973—）, 男, 主治医师, 博士；电子信箱: zhaofenglu001@163.com。

Minimally-invasive surgical treatment of 58 patients with epidural hematoma straddling transverse sinus

LU Zhao-feng1, QIU Yong-ming2, CHENG Xiao-bing1, MENG Xiao-feng1   

  1. 1.Department of Neurosurgery, the First Affiliated Hospital of Henan University of Science and Technology, Luo yang471001, China；2.Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Online:2012-08-28 Published:2012-08-29

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摘要：

目的 探讨微创血肿引流术对横窦骑跨性硬膜外血肿的治疗效果。方法 58例创伤性横窦骑跨性硬膜外血肿患者术前格拉斯哥昏迷评分(GCS）8～12分，均在CT定位下以YL-1微创引流针穿刺血肿腔，并以尿激酶50 000～60 000 IU冲洗引流。术后1 h、3 d及7 d行CT动态扫描，计算血肿量；术后3个月行格拉斯哥预后评分（GOS）。结果 CT显示术后1 h血肿量平均为（20±5）mL，术后3 d为(15±2) mL，均较术前的（45±15）mL显著减少（均P＜0.05）。术后3～5 d血肿均完全清除。术后5 d平均GCS为（12±1）分，较术前的（8±4）分显著提高（P＜0.05）。术后3个月GOS 5分（恢复良好）者45例（占78%），4分（中度残疾）者9例（占16%）。结论 微创血肿引流术对GCS≥8分的创伤性横窦骑跨性硬膜外血肿疗效确切，创伤小且操作简便。

关键词: 横窦骑跨性硬膜外血肿, 微创引流, 格拉斯哥昏迷评分

Abstract:

Objective To investigate the therapeutic effect of minimally-invasive drainage on epidural hematoma straddling transverse sinus. Methods Fifty-eight patients with traumatic epidural hematoma straddling transverse sinus and preoperative Glasgow Coma Score (GCS) 8 to 12 points were managed with minimally-invasive drainage under CT location, and 50 000 to 60 000 IU of urokinase was used for irrigation and drainage. CT scanning was performed 1 h, 3 d and 7 d after operation, volumes of hematoma were calculated, and Glasgow Outcome Score (GOS) was evaluated 3 months after operation. Results The volumes of hematoma 1 h and 3 d after operation were (20±5) mL and (15±2) mL respectively, and were significantly lower than that before operation [(45±15) mL](P＜0.05). The hematoma was totally removed 3 to 5 d after operation. GCS was (12±1) points 5 d after operation, which was significantly higher than that before operation [(8±4) points](P＜0.05). Three months after operation, good recovery (GOS 5 points) was achieved in 45 patients (78%), and moderate disability (GOS 4 points) was found in 9 patients (16%). Conclusion Minimally-invasive drainage is effective in the treatment of traumatic epidural hematoma straddling transverse sinus with GCS≥8 points.

Key words: epidural hematoma straddling transverse sinus, minimally invasive drainage, Glasgow Coma Score