[1]韦可,杜威,陈大瑜,等.锥颅软通道引流术治疗儿童急性创伤性颅内血肿[J].中国临床神经外科杂志,2023,28(10):646-648.[doi:10.13798/j.issn.1009-153X.2023.10.011]
　WEI Ke,DU Wei,CHEN Da-yu,et al.Cranial puncture and drainage under CT guidance for acute traumatic intracranial hematomas in children[J].,2023,28(10):646-648.[doi:10.13798/j.issn.1009-153X.2023.10.011]
点击复制

锥颅软通道引流术治疗儿童急性创伤性颅内血肿()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年10期
页码:
646-648
栏目:
论著
出版日期:
2023-10-31

文章信息/Info

Title:
Cranial puncture and drainage under CT guidance for acute traumatic intracranial hematomas in children
文章编号:
1009-153X（2023）10-0646-03
作者:
韦可; 杜威; 陈大瑜; 杨柳; 姚国杰
430070武汉，中部战区总医院神经外科（韦可、杜威、陈大瑜、杨柳、姚国杰）
Author(s):
WEI Ke;  DU Wei;  CHEN Da-yu;  YANG Liu;  YAO Guo-jie
Department of Neurosurgery, General Hospital of Central Theater Command, Wuhan 430070, China
关键词:
急性颅脑损伤; 颅内血肿; 锥颅引流术; 儿童
Keywords:
Traumatic brain injury;  Intracranial hematomas;  Cranial puncture and drainage;  Children
分类号:
R 651.1+5; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2023.10.011
文献标志码:
A
摘要:
目的 探讨CT定位辅助锥颅软通道引流术治疗儿童急性创伤性颅内血肿的疗效。方法 回顾性分析2016年5月至2021年10月收治的42例急性创伤性颅内血肿患儿的临床资料。结果 硬膜外血肿26例，血肿量（25.5±5.53）ml；脑挫裂伤并脑内血肿12例（单发8例，多发4例），血肿量（20.25±2.2）ml；基底节区血肿4例，血肿量（20.75±2.38）ml。行CT定位锥颅穿刺软通道引流术，引流2~5 d，引流量20~60 ml。42例患儿均顺利出院，无颅内感染及迟发性出血等并发症，无癫痫发作。出院时，6例患儿肢体轻瘫，康复治疗半年基本恢复正常生活、学习；其余36例疗效满意，认知力、理解力正常，肢体功能恢复好，生活自理能力好。结论儿童对颅脑损伤开颅手术耐受力差，极易造成失血性休克、内环境紊乱，开颅风险高于成人。对伴有血肿的急性颅脑损伤患儿，行CT定位辅助锥颅穿刺软通道引流术，创伤小，恢复快，能够减少患儿的风险与痛苦，并可取得优良的疗效。
Abstract:
Objective To explore the clinical efficacy of CT-guided cranial puncture and drainage for pediatric acute traumatic intracranial hematomas. Methods The clinical data of 42 children with acute traumatic intracranial hematomas treated from May 2016 to October 2021 were retrospectively analyzed. Results Twenty-six patients had epidural hematomas with a mean hematoma volume of (25.5±5.53) ml. Twelve patients had cerebral contusion and laceration complicated with intracerebral hematoma with a mean hematoma volume of (20.25±2.2) ml. Four patients had hematoma in basal ganglia with a mean hematoma volume of (20.75±2.38) ml. Cranial puncture and drainage under CT guidance was performed in all 42 children for 2~5 days with a drainage volume of 20~60 ml. All 42 patients were discharged from hospital without intracranial infection, delayed hemorrhage, seizure and other complications. On discharge, 6 patients had limb palsy, which was returned to normal after rehabilitation treatment for half a year, and the other 36 patients had satisfactory curative effect, normal cognition and understanding, good recovery of limb function, and good self-care ability. Conclusions Children have poor tolerance to craniotomy for traumatic brain injury, which is easy to cause hemorrhagic shock and internal environment disorder, and the risk of craniotomy is higher than that of adults. For children with acute traumatic brain injury accompanied by hematoma, Cranial puncture and drainage assisted with CT positioning is less traumatic, faster recovery, and can reduce the risk and pain of children, and can obtain excellent curative effect.

参考文献/References:

[1]KOCHAR A, BORLAND ML, PHILLIPS N, et al. Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury [J]. Emerg Med J, 2020, 37(3): 127-134.
[2]李政委，王杭州，朱炳鑫，等. 学龄前儿童中重型颅脑损伤预后不良相关因素分析[J]. 临床外科杂志，2020，28（6）：545-547.
[3]章　成，曹灵红. 儿童颅脑继发性损伤预后的影响因素分析[J]. 西部医学，2015，27（12）：1816-1818.
[4]陈　静，石　磊，刘　宇，等. 儿童颅脑损伤的临床特点及手术策略（附257例分析）[J]. 中国现代手术学杂志，2013，17（1）：47-50.
[5]UMERANI MS, ABBAS A, AZIZ F, et al. Pediatric extradural hematoma: clinical assessment using king's outcome scale for childhood head injury [J]. Asian J Neurosurg, 2018, 13(3): 681-684.
[6]方江顺，王贤书，杨志国，等. 颅骨钻孔引流联合尿激酶溶栓治疗小儿创伤性硬膜外血肿的效果观察[J]. 实用心脑肺血管病杂志，2018，26（12）：87-90.
[7]谭　翔，唐松林，吕克刚，等. 儿童颅脑损伤及手术治疗的特点[J]. 医学临床研究，2009，26（3）：544-545.
[8]JACKSON TL, BRAUN JM, MELLO M, et al. The relationship between early childhood head injury and later life criminal behaviour: a longitudinal cohort study [J]. J Epidemiol Community Health, 2017, 71(8): 800-805.
[9]刘　娜，姜　辉. 儿童颅脑损伤影像学检查的研究进展[J]. 医学综述，2020，26（21）：4324-4327，4332.
[10]蒋宇钢，谭志刚. 儿童颅脑损伤诊治应注意的几个问题[J]. 创伤外科杂志，2017，19（6）：401-404.

相似文献/References:

[1]钟未鸣　许友松　董　斌　张　建　傅　鑫　魏　祎　庞春晓.破裂大脑中动脉动脉瘤伴颅内血肿的超早期手术治疗[J].中国临床神经外科杂志,2016,(08):500.[doi:10.13798/j.issn.1009-153X.2016.08.022]
[2]孙其凯　李珍珠　曹智洁　高　强　王清波　陈　正　耿　鑫　李泽福.3D打印模型引导下经颞部穿刺引流术治疗颅内血肿[J].中国临床神经外科杂志,2016,(10):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
　SUN Qi-kai,LI Zhen-zhu,CAO Zhi-jie,et al.Treatment of hypertensive cerebral hemorrhage by the minimally invasive puncture via temporal region under the guidance of 3D printing model[J].,2016,(10):586.[doi:10.13798/j.issn.1009-153X.2016.10.004]
[3]段继新,钟治军,刘　渊,等.外伤性颅内血肿合并严重颅底骨折治疗体会[J].中国临床神经外科杂志,2016,(11):713.[doi:10.13798/j.issn.1009-153X.2016.11.023]
[4]许乐宜,陈　丽,费智敏,等.脑干听觉诱发电位在颅脑损伤诊治中的应用[J].中国临床神经外科杂志,2016,(12):744.[doi:10.13798/j.issn.1009-153X.2016.12.004]
　XU Le-yi,CHEN Li,FEI Zhi-min,et al.Application of brainstem auditory evoked potential to diagnosis and treatment of acute craniocerebral trauma[J].,2016,(10):744.[doi:10.13798/j.issn.1009-153X.2016.12.004]
[5]肖高华　陈　钢　陈　峥　刘　科　刘　笑　熊绍棠.急性颅脑损伤外周血垂体前叶激素及脑脊液硫化氢水平变化[J].中国临床神经外科杂志,2017,(05):310.[doi:10.13798/j.issn.1009-153X.2017.05.009]
　XIAO Gao-hua,CHEN Zheng,CHEN Gang,et al.Changes of plasma anterior pituitary hormone and CSF H2S in patients with acute craniocerebral trauma[J].,2017,(10):310.[doi:10.13798/j.issn.1009-153X.2017.05.009]
[6]曹成龙 李艳玲 宋　健 姚　顺 房　莉 闫　研 徐国政.急性中、重型颅脑损伤早期病死率的预测：Marshall CT分级和Rotterdam CT评分的比较[J].中国临床神经外科杂志,2017,(10):676.[doi:10.13792017.09/j.issn.1009-153X.2017.10.002]
　CAO Cheng-long,LI Yan-ling,SONG Jian,et al.Prediction of early death in patients with traumatic brain injury: a comparison between Marshall and Rotterdam CT scoring systems[J].,2017,(10):676.[doi:10.13792017.09/j.issn.1009-153X.2017.10.002]
[7]梁　伟　张学军　王东挺　祝　韬.颅脑损伤开颅术后并发颅内血肿危险因素分析[J].中国临床神经外科杂志,2017,(12):819.[doi:10.13798/j.issn.1009-153X.2017.12.006]
　LIANG Wei,ZHANG Xue-jun,WANG Dong-ting,et al.Analysis of risk factors related to intracranial hematoma after craniotomy in patients with traumatic brain injury[J].,2017,(10):819.[doi:10.13798/j.issn.1009-153X.2017.12.006]
[8]文　明　李昊旻　杨先清.75岁以上高龄颅内血肿微创手术治疗体会[J].中国临床神经外科杂志,2019,(09):556.[doi:10.13798/j.issn.1009-153X.2019.09.015]
[9]陈华辉　王文雄　张刚利　张梦杰　张　豪.促红细胞生成素治疗急性颅脑损伤疗效的meta分析[J].中国临床神经外科杂志,2019,(11):662.[doi:10.13798/j.issn.1009-153X.2019.11.008]
　CHEN Hua-hui,WANG Wen-xiong,ZHANG Gang-li,et al.Effect of erythropoietin on acute traumatic brain injury and its safety: a meta-analysis[J].,2019,(10):662.[doi:10.13798/j.issn.1009-153X.2019.11.008]
[10]王　康　彭逸龙　李小辉　黄　戈　伍　益.软通道技术在中等量颅内血肿治疗中的应用[J].中国临床神经外科杂志,2020,(02):101.[doi:10.13798/j.issn.1009-153X.2020.02.013]
[11]郭　浩　蔺　慧　郭建平.中青年与老年急性颅脑损伤颅内血肿动态变化对比分析[J].中国临床神经外科杂志,2017,(01):20.[doi:10.13798/j.issn.1009-153X.2017.01.007]
　GUO Hao,LIN Hui,GUO Jian-ping..Dynamic changes in intracranial hematomas in young and middle-aged patients and the senile with acute craniocerebral trauma[J].,2017,(10):20.[doi:10.13798/j.issn.1009-153X.2017.01.007]

备注/Memo

备注/Memo:
（2023-08-21收稿，2023-09-28修回）
通讯作者：姚国杰，E-mail：yaoguojieygj@163.com
更新日期/Last Update: 2023-10-31