摘要
目的观察采用血肿清除及去骨瓣减压术治疗颅内静脉窦血栓形成(CVST)合并脑出血所致脑疝患者的疗效。方法回顾性分析哈尔滨医科大学第二附属医院2009年5月—2011年9月采用脑内血肿清除及去骨瓣减压术治疗的CVST合并脑出血所致脑疝患者的临床资料,共7例,术后华法林抗凝治疗6个月。观察患者的治疗效果。结果 7例中,出院时按格拉斯哥预后评分评估,恢复良好3例,轻残1例,重残1例;另2例患者术后短期瞳孔恢复,血肿清除彻底,脑移位回复,但分别于术后1d和2d又出现对侧瞳孔散大,CT显示对侧有散在的斑片状出血灶,伴有周围脑组织严重水肿和缺血的改变,其中植物状态1例,死亡1例。7例均未发生与手术直接相关的并发症。随访6～12个月,无静脉窦血栓形成复发及再发颅内出血的患者。结论对于CVST合并脑出血引起脑疝的患者,行血肿清除及去骨瓣减压术是必要和有效的治疗方法,术后发生其他部位再出血的患者预后不佳。
Objective To observe the efficacy of the treatment in patients with brain herniation caused by cerebral venous sinus thrombosis （CVST）combined with intraeerebral hemorrhage using hematoma evacuation and decompressive craniectomy. Methods The clinical data of 7 patients with brain herniation caused by intracerebral hemorrhage treated with intraeerebral hematoma evacuation and de-compressive cranieetomy at the Second Affiliated Hospital of Harbin Medical University from May 2009 to September 2011 were analyzed retrospectively. They were treated with warfarin anticoagulation therapy for 6 months after procedure. The treatment outcomes of the patients were observed. Results According to the Glasgow outcome scale scores at discharge, 7 of the 3 patients had good recovery, 1 remained mild disabili-ty, and 1 remained severe disability; the other 2 had short-term pupil recovery. Their hematomas were evacuated completely and the brain shift returned to normal, hut they had contralateral mydriasis at day 1 and day 2 after procedure. CT showed scattered patchy hemorrhagic loci with severe edema and isehemic changes in the surrounding brain tissue. One of them had persistent vegetative state and the other died. The 7 patients did not had direct complications associated with the procedure. They were followed up for 6 to 12 months. None of them had recurrence of CVST and intraeranial hemorrhage. Conclusion As for brain herniation caused by intraeerebral hemorrhage in patients with CVST, hematoma evacuation and decompres-sire craniectomy is the necessary and effective treatment, and the prognosis is poor if rebleeding occur at other parts of the brain after the procedure.
出处
《中国脑血管病杂志》
CAS
2012年第12期648-651,共4页
Chinese Journal of Cerebrovascular Diseases
关键词
窦血栓形成
颅内
脑出血
脑疝
去骨瓣减压术
Sinus thrombosis, intracranial
Brain hemorrhage
Brain herniation
Decompressivecraniectomy
