【摘要】 目的 总结重型颅脑损伤术中急性脑膨出救治的经验。方法 回顾性分析大坪医院自1997年7月～2007年1月37例术中出现急性脑膨出的重型颅脑损伤患者的临床资料。结果 CT复查示迟发性颅内血肿26例，弥漫性脑肿胀7例，挫裂伤脑水肿2例;另2例未行CT复查原因不清。对侧钻孔确认后直接开颅7例，手术过程中复查CT后手术5例，关颅后复查CT再手术20例，未复查切除脑叶者2例。死亡7例，包括4例弥漫性脑肿胀患者。伤后半年GOS评估，植物生存1例，重残3例，中残6例，良好20例。结论术中出现脑膨出时，首先考虑对侧迟发性颅内血肿可能，对侧可疑部位钻孔探查手术，或快速CT复查，明确诊断后再次手术。梯度减压开颅、异丙酚麻醉、控制性低血压及去骨瓣减压是防治弥漫性脑肿胀的救治措施。
【关键词】 颅脑损伤; 脑膨出;颅内血肿;脑肿胀
Management of intraoperative acute encephalocele during clot evacuation in severe brain injury
XU Lunshan,XU Minhui,CHEN Guangxin,et al.
(Department of Neurosurgery,Institute of Surgery Research，Daping Hospital，Third Mililtary Medical University，
Chongqing 400042,China)
Abstract： Objective To summarize the causes and strategies of management of intraoperative acute encephalocele in severe brain injury.Methods During a tenyear period(July 1997Jan 2007),the clinical diagnosis,operative events,and CT findings in 37 cases suffering from acute open brain herniation were reviewed.Results The intraoperative acute encephalocele occurred in 37 patients with severe brain injury,among whom,26 suffered from delayed intracranial hematomas,7 from acute diffuse brain swelling,and 3 from delayed onset of massive oedema around the contusion.A contralateral craniectomy was performed after trepanation without CT scan in 7 patients,in 5 patients CT was performed before scalp closure,2 underwent a lobectomy without CT scan,while the other 20 cases had consecutive surgeries according to the fingdings of CT scan after scalp closure.Of the 37 cases with intraoperative acute encephalocele,20 patients had a good outcome,6 moderately disabled,3 severely disabled,1 survived as persistent vegetative state,and 7 died.Conclusion Intraoperative acute encephalocele is mainly caused by delayed intracranial hematomas.It should be effectively treated by early craniotomy after diagnosis by emergency CT scan,or trepanation according to the skull fracture immediately
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