彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

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Abstract Objective To investigate the applicability of ultrasound in the diagnosis and surgical treatment of acute encephaloceles with severe craniocerebral injury. Methods The clinical data on 32 patients who had developed acute encephaloceles during surgery for severe craniocerebral injury in Beijing Municipal Corps Hospital and Sichuan Provincial Corps Hospital of Chinese People's Armed Police Force between December 2013 and December 2018 was retrospectively analyzed. Ultrasonography was used during the operations to diagnose the cause of encephaloceles and to guide the related surgeries. Furthermore, the etiological category and site characteristics (including cases) of encephaloceles diagnosed by intraoperative ultrasonography were observed, while the Glasgow Outcome Score (GOS) was recorded 6 months after surgery. Results According to the characteristics of skull fractures shown by preoperative CT in 8 cases, it was speculated that the cause of intraoperative encephaloceles might have been delayed intracranial hematoma on the contralateral side. Intraoperative ultrasonography confirmed that the contralateral skull fracture was delayed epidural hematoma and subdural hematoma. The etiology of encephaloceles was difficult to determine in other 24 cases, but could be revealed by ultrasound examination which showed 9 cases of epidural hematoma or subdural hematoma on the contralateral side of the surgery, 7 cases of intracerebral hematoma on the same side of the surgery, 2 cases of extramembranous hematoma, 2 cases of subdural hematoma and 4 cases of severe ipsilateral contusion and extensive brain swelling. Thirty-two cases had their intracranial hematoma or contused brain tissue surgically removed under ultrasound guidance, which effectively relieved the brain bulge. Six months after operations, the 32 patients were classified according to the Glasgow Outcome Score (GOS). Eight cases were classified as good recovery (25.00%), 9 cases moderate disability (28.12%), 7 cases severe disability (21.88%), 4 cases persistent vegetative state (12.50%) and 4 cases died (12.50%). Conclusions Intraoperative ultrasound can accurately diagnose the cause of acute encephaloceles during severe head injury,facilitate surgical treatment of encephaloceles, shorten the duration of surgery and raise the success rate of treatment.

Key words： severe craniocerebral injury encephalocele intracranial hematoma intraoperative ultrasound

Received: 20 March 2021

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	SUN Yongfeng
	XIAN Dengqin
	LI Yuhuan
	LIU Huizhao
	SHI Lei

Cite this article:

SUN Yongfeng,XIAN Dengqin,LI Yuhuan等. Applicability of ultrasound in diagnosis and treatment intraoperative acute encephaloceles with severe craniocerebral injury[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(1): 1-4.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2022/V33/I1/1

[1]	Du T J, Jing X Y, Song S,et al. Therapeutic effect of enteral nutrition supplemented with probiotics in the treatment of severe craniocerebral injury: a systematic review and meta-analysis.[J].World Neurosurg, 2020, 139(7): e553-e571.
[2]	Jiang H S, Wang Y Z, Super early cranial repair improves the prognosis of patients with craniocerebral injury[J].J Int Med Res, 2020, 48(9): 300060520959485.
[3]	Pons E, Foks K A, Dippel D W J, et al. Impact of guidelines for the management of minor head injury on the utilization and diagnostic yield of CT over two decades, using natural language processing in a large dataset [J]. Eur Radiol, 2019, 29(5): 2632-2640.
[4]	熊学辉,瞿丹霞,罗杰.改良去大骨瓣控制性减压术治疗重型颅脑损伤疗效分析[J].医学信息,2015,28(52): 54-55.
[5]	葛键,王维东,汤德刚.控制减压策略在去骨瓣减压术治疗重、特重度颅脑损伤的临床应用[J].立体定向和功能性神经外科杂志,2016(3):172-174.
[6]	韩永强,李泽明,石斌.控制性阶梯式颅内减压手术治疗重型颅脑损伤的疗效观察[J].中国药物与临床,2017, 17(3): 420-422.
[7]	刘海兵,王守森,洪景芳,等.重型颅脑损伤术中急性脑膨出与损伤部位的相关性分析[J].中国微侵袭神经外科杂志,2018,23(12):8-11.
[8]	谢永锋.重型颅脑损伤术中急性脑膨出的临床分析[J].中国实用神经疾病杂志, 2016, 19(14): 110-110.
[9]	刘海兵,王守森,洪景芳, 等.重型颅脑损伤术中急性脑膨出与损伤部位的相关性分析[J].中国微侵袭神经外科杂志, 2018, 23(12): 532-535.
[10]	徐守仕,田福.逐步控制性减压手术治疗重型颅脑损伤的疗效分析[J].中国实用神经疾病杂志,2015,18( 3) : 116-117.
[11]	印晓鸿,王远传,段劼, 等.颅脑损伤患者开颅术中急性脑膨出的原因及预防策略[J].中国急救复苏与灾害医学杂志,2019,14(2):140-142.
[12]	Li Z D, Zou D H, Zhang J H, et al. Use of 3D reconstruction of emergency and postoperative craniocerebral CT images to explore craniocerebral trauma mechanism[J]. Forensic Sci Int, 2015, 255(10):106-111.
[13]	黄沃斌,吕建光,李柱辉.创伤性颅脑损伤患者开颅术中急性脑膨出的危险因素研究[J].实用心脑肺血管病杂志, 2017, 25(6): 19-22.
[14]	周待令.控制性阶梯式减压术治疗重型颅脑损伤 68 例临床分析[J].中国实用神经疾病杂志,2016,19( 20) : 39-41.
[15]	卢燕敏,孙异春,戚小艺,等. 术中超声在重型颅脑损伤脑膨出病因诊断中的价值[J].深圳中西医结合杂志,2019, 29(16):13-15.
[16]	Korley F K, Diaz-Arrastia R, Falk H J, et al. Prevalence of incomplete functional and symptomatic recovery among patients with head injury but brain injury debatable [J]. J Neurotrauma, 2017,34(8):1531-1538.
[17]	张杰,李世樟,朱栋梁.实时超声在重型颅脑损伤标准大骨瓣减压术中的应用[J].2015, 32(3): 478-480.
[18]	周军格,岑波,胡飞. 凸阵探头超声在重型颅脑损伤术中的应用[J].中国临床神经外科杂志,2017,22(2):105-106.
[19]	杨帆,高嵘,俞亮,等.术中 B 型超声在神经外科手术中的应用研究[J].系统医学,2017,2(10):111-113.

[1]	. [J]. Med. J. Chin. Peop. Armed Poli. Forc., 2017, 28(9): 927-928.