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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摘要目的探讨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。方法回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案。观察记录术中超声诊断脑膨出的病因类别、部位特点(包括例数)及指导手术后6个月时的格拉斯哥预后评分(Glasgow outcome score,GOS)。结果本组中8例根据术前CT所示的颅骨骨折特点,推测术中脑膨出的病因可能为对侧出现迟发性颅内血肿,术中超声检查证实对侧颅骨骨折部位为迟发性硬膜外血肿及硬膜下血肿。本组24例术前难以判断脑膨出的病因,经术中超声检查发现:手术对侧硬膜外血肿或硬膜下血肿9例,手术同侧出现脑内血肿7例,手术区域临近及远隔部位硬膜外血肿2例、硬膜下血肿2例,手术同侧挫裂伤情况加重、广泛性脑肿胀4例。32例均在超声引导下手术清除颅内血肿或挫伤的脑组织,有效缓解脑膨出。术后6个月,按GOS分级为:恢复良好8例(25.00%),中度残疾9例(28.12%),重度残疾7例(21.88%),植物生存状态4例(12.50%),死亡4例(12.50%)。结论术中超声能准确诊断重型颅脑损伤急性脑膨出的病因及进一步指导手术治疗脑膨出,缩短手术时间,提高救治成功率。

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	孙永锋
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	石磊

关键词 ：重型颅脑损伤, 脑膨出, 颅内血肿, 术中超声

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

收稿日期: 2021-03-20

ZTFLH:

R651.15

通讯作者: 仙登沁,E-mail:xiandengqin@yeah.net

作者简介: 孙永锋,本科学历,主任医师。

引用本文:

孙永锋, 仙登沁, 李煜环, 刘会昭, 石磊. 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[J]. 武警医学, 2022, 33(1): 1-4. SUN Yongfeng, XIAN Dengqin, LI Yuhuan, LIU Huizhao, SHI Lei. Applicability of ultrasound in diagnosis and treatment intraoperative acute encephaloceles with severe craniocerebral injury. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(1): 1-4.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I1/1

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