摘要： 目的 比较跨窦小骨窗颅骨切开术（小骨窗手术）与幕上-幕下联合颅骨切开术（常规手术）清除非进展性跨窦硬膜外血肿的手术效果。方法 共67 例非进展性跨窦硬膜外血肿患者分别采用两种手术方式清除血肿，比较两组患者术后窦旁血肿残留量、颅内压变化、静脉窦通畅情况、住院时间，以及术后6 个月时Glasgow 预后分级（GOS）评分。结果 与常规手术组相比，小骨窗手术组患者术后窦旁血肿残留量［（1.40 ± 1.60）ml 对（3.50 ± 2.10）ml，P = 0.000］和住院时间［（13.40 ± 5.70）d 对（17.30 ± 7.00）d，P = 0.015］减少，术后颅内压［1 d：（164.40 ± 33.30）mm H2O 对（198.60 ± 49.30）mm H2O，P = 0.002；3 d：（185.90 ± 47.80）mm H2O 对（226.30 ± 81.60）mm H2O，P = 0.017；7 d：（154.70 ± 52.50）mm H2O 对（198.30 ± 84.20）mm H2O，P = 0.014］降低，术后静脉窦通畅率提高（87.50%对65.70%，P = 0.037）。两组患者术后6 个月GOS 评分差异无统计学意义（Z = -0.114，P = 0.909）。结论 跨窦小骨窗颅骨切开术可有效清除非进展性跨窦硬膜外血肿，尤其是窦旁血肿清除较彻底，可有效解除静脉窦受压、改善静脉窦回流障碍、降低颅内压，是清除非进展性跨窦硬膜外血肿的可靠术式。
关键词:
血肿, 硬膜外, 颅内,
颅骨切开术
Abstract: Objective To investigate the clinical efficacy of two surgical approaches, trans-sinus small-window craniotomy (TSSWCT) and combined supratentorial-infratentorial craniotomy (CSITCT), on non-progressive trans-sinus epidural hematoma. Methods There were 67 patients with non-progressive trans-sinus epidural hematoma who underwent TSSWCT or CSITCT. The postoperative residual hematoma, postoperative alteration of intracranial pressure (ICP), recanalization of affected cerebral venous sinuses, length of hospitalization, and 6-month Glasgow Outcome Scale (GOS) score of patients were retrospectively compared. Results Compared with patients in the CSITCT group (N = 35), those in the TSSWCT group (N = 32) had significantly reduced postoperative residual hematoma near the venous sinus [(1.40 ± 1.60) ml vs (3.50 ± 2.10) ml, P = 0.000], length of hospitalization [(13.40 ± 5.70) d vs (17.30 ± 7.00) d, P = 0.015], markedly down-regulated levels of intracranial pressure (ICP) at indicated postoperative time points [1 d: (164.40 ± 33.30) mm H2O vs (198.60 ± 49.30) mm H2O, P = 0.002; 3 d: (185.90 ± 47.80) mm H2O vs (226.30 ± 81.60) mm H2O, P = 0.017; 7 d: (154.70 ± 52.50) mm H2O vs (198.30 ± 84.20) mm H2O, P = 0.014)], and distinctly improved recanalization of affected cerebral venous sinuses (87.50% vs 65.70% , P = 0.037). Moreover, the 6-month GOS scores were not statistically different between patients in 2 groups (Z = -0.114, P = 0.909). Conclusions Compared with CSITCT, TSSWCT is a reliable surgical approach in the treatment of non-progressive trans-sinus epidural hematoma which has strengthened capability of evacuating hematoma underlying affected venous sinuses, relieving the compressed venous sinus and attenuating the intracranial hypertension.
Key words:
Hematoma, epidural, cranial,
Craniotomy
胡连水, 王文浩, 林洪, 林俊明, 李君, 罗飞, 张源. 小骨窗开颅治疗非进展性跨窦硬膜外血肿[J]. 中国现代神经疾病杂志, 2015, 15(2): 142-147.
HU Lian-shui, WANG Wen-hao, LIN Hong, LIN Jun-ming, LI Jun, LUO Fei, ZHANG Yuan. The clinical efficacy of small-window craniotomy on non-progressive trans-sinus epidural hematoma[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2015, 15(2): 142-147.