Labbe's静脉引流区脑挫裂伤的临床特点与手术治疗
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摘要
目的探讨Labbe's静脉区脑挫裂伤的临床特点,以及形成机制、挫裂伤灶发展特点、手术方法和降低其致死致残率的措施。方法回顾性分析近5年来收治的29例Labbe's引流区脑挫裂伤患者的临床资料。总结其临床表现、受伤机制﹑影像学﹑疾病发展特点﹑术中所见﹑后续并发症,以及处理措施和预后等。结果该区损伤自有特点,术中均证实存在静脉性损伤;迟发血肿发生率较高,挫裂伤灶水肿范围大,创面止血困难;后期病情变化大,是影响预后的重要因素。结论针对Labbe's静脉区脑挫裂伤损伤特点,及时进行影像学检查,及时手术,以及合适的手术方法;结合术后的病情监测与治疗,可以降低病死率和致残率。
Objective To explore the mechanism of injury of brain in Labbe's venous drainage area,the development of lesion and operative skill. Methods A total of 29 cases of patients with contusion and laceration of brain were analyzed in the past five years. We reviewed the data of imaging characteristics,disease development,what we could see during the operation,the subsequent development of complications and clinical prognosis and so on.Results The lesion of Labbe's venous drainage area has special features. It has been proved that veins were lesioned during intraoperative,and the incidence rate of late-onset type cerebral hemorrhage is high,and the range in the cerebral edema of contusion and laceration is large,and the hemorrhage is stopped difficultly,the pathogenetic condition get worse quickly at the later stage,which is the important factors affecting prognosis independently.Conclusion On the basis of the lesion features of Labbe's venous drainage area in contusion and laceration of brain,the mortality and morbidity can be reduced if the patients are examined by CT scan timely,are operated timely with appropriate skills,and are combined with postoperative standard treatment.
Objective To explore the mechanism of injury of brain in Labbe's venous drainage area,the development of lesion and operative skill. Methods A total of 29 cases of patients with contusion and laceration of brain were analyzed in the past five years. We reviewed the data of imaging characteristics,disease development,what we could see during the operation,the subsequent development of complications and clinical prognosis and so on.Results The lesion of Labbe's venous drainage area has special features. It has been proved that veins were lesioned during intraoperative,and the incidence rate of late-onset type cerebral hemorrhage is high,and the range in the cerebral edema of contusion and laceration is large,and the hemorrhage is stopped difficultly,the pathogenetic condition get worse quickly at the later stage,which is the important factors affecting prognosis independently.Conclusion On the basis of the lesion features of Labbe's venous drainage area in contusion and laceration of brain,the mortality and morbidity can be reduced if the patients are examined by CT scan timely,are operated timely with appropriate skills,and are combined with postoperative standard treatment.
引文
[1]Fridley J.Thomas J,Kitagawa R,et al.Immediate development of a contralateral acute subdural hematoma following acute subdural hematoma evacuation[J].J Clin Neurosci,2011,18:422.
[2]Zhang LW,Wang ZC.Preference in traumatic of Labbe's venous and the way to deal with[J].Chin J Neurosurg,2003,19:456.
[3]李勇,姜永亮,黄波.颅脑损伤后动、静脉性脑梗死的相关危险因素分析[J].中国临床神经外科杂志,2015,20:284.
[4]孙起军,王尚武,向九大,等.颅脑损伤急诊手术非手术部位迟发性颅内血肿临床分析[J].中华临床医师杂志(电子版),2011,5:4567.
[5]邹钦,阳小生,吴小兵,等.外侧裂区脑挫裂伤伴侧裂静脉损伤的手术治疗[J].南华大学学报:医学版,2009,37:581.
[6]Fridley J,Thomas J,Kitagawa R,et al.Immediate development of a contralateral acute subdural hematoma following acute subdural hematoma evacuation[J].J Clin Neurosci,2011,18:422.
[7]林俊杰,刘泽洪,孙建中,等.Labbe's静脉受损相关的急性硬膜下血肿的处理[J].浙江创伤外科,2008,13:449.
[8]刘保华,张建永,姜宁,等.显微手术治疗外侧裂区脑挫裂伤(附126例分析)[J].临床神经外科杂志,2006,3:122.
[9]芮女芳,张进贤,楼永锋,等.硬膜外血肿手术后脑水肿临床多因素分析.[J]中国现代医生,2011,49:40.
[10]张岩松,常义.颞叶静脉引流形式及其外科保护方法[J].中国微侵袭神经外科杂志,2005,10:280.
[11]Lee YB,Jeong HS.Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period[J].J Korean Soc Traumatol,2010,23:142.
[12]王卫广,肖接成,陆士其,等.急性外伤性颅内血肿开颅术后再发血肿危险因素的L ogistic回归分析[J].中国急救医学杂志,2012,32:300.[1
[13]罗安志,龙鸿川,俨奇伟,等.脑外伤迟发颅内出血与凝血异常关系研究[J].中华实用诊断与治疗杂志,2010,24:971.
[14]刘保华,熊方令,蔡旺,等.动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义[J].临床神经外科杂志,2014,11:128.[15]C han CM,Zilberberg MD.Preference in traumatic intracranial hemorrhage:bleeding vs clotting[J].Crit Care,2010,14:153.
[2]Zhang LW,Wang ZC.Preference in traumatic of Labbe's venous and the way to deal with[J].Chin J Neurosurg,2003,19:456.
[3]李勇,姜永亮,黄波.颅脑损伤后动、静脉性脑梗死的相关危险因素分析[J].中国临床神经外科杂志,2015,20:284.
[4]孙起军,王尚武,向九大,等.颅脑损伤急诊手术非手术部位迟发性颅内血肿临床分析[J].中华临床医师杂志(电子版),2011,5:4567.
[5]邹钦,阳小生,吴小兵,等.外侧裂区脑挫裂伤伴侧裂静脉损伤的手术治疗[J].南华大学学报:医学版,2009,37:581.
[6]Fridley J,Thomas J,Kitagawa R,et al.Immediate development of a contralateral acute subdural hematoma following acute subdural hematoma evacuation[J].J Clin Neurosci,2011,18:422.
[7]林俊杰,刘泽洪,孙建中,等.Labbe's静脉受损相关的急性硬膜下血肿的处理[J].浙江创伤外科,2008,13:449.
[8]刘保华,张建永,姜宁,等.显微手术治疗外侧裂区脑挫裂伤(附126例分析)[J].临床神经外科杂志,2006,3:122.
[9]芮女芳,张进贤,楼永锋,等.硬膜外血肿手术后脑水肿临床多因素分析.[J]中国现代医生,2011,49:40.
[10]张岩松,常义.颞叶静脉引流形式及其外科保护方法[J].中国微侵袭神经外科杂志,2005,10:280.
[11]Lee YB,Jeong HS.Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period[J].J Korean Soc Traumatol,2010,23:142.
[12]王卫广,肖接成,陆士其,等.急性外伤性颅内血肿开颅术后再发血肿危险因素的L ogistic回归分析[J].中国急救医学杂志,2012,32:300.[1
[13]罗安志,龙鸿川,俨奇伟,等.脑外伤迟发颅内出血与凝血异常关系研究[J].中华实用诊断与治疗杂志,2010,24:971.
[14]刘保华,熊方令,蔡旺,等.动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义[J].临床神经外科杂志,2014,11:128.[15]C han CM,Zilberberg MD.Preference in traumatic intracranial hemorrhage:bleeding vs clotting[J].Crit Care,2010,14:153.