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| Clinical experience analysis of standard large decompressive craniectomy and internal decompression to treat acute massive infraction decompression in large area |
| Yuan Jun-hui, Shi Dong-fu, Lv Yan-song, Dong Chao-feng, Zhang Shao-wei, Cui Bo |
| Department of Neurosurgery, Sanmenxia City Central Hospital, Sanmenxia 472000, China |
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Abstract Objective To analyze the clinical efficacy of standard large decompressive craniectomy and internal decompression to treat acute massive infraction decompression in large area. Methods We reviewed the clinical data of 119 patients who were diagnosed as acute massive infraction decompression in large area in our hospital from February 2013 to March 2017, in which 62 patients were treated by standard large decompressive craniectomy and internal decompression, and the rest 57 patients were treated by standard large decompressive craniectomy only.The prognosis and surgical experience were analyzed retrospectively. Results There was no difference in cerebral infarction and (Glasgow Coma Scale) GCS in two groups (P＞0.05). But there was a significant difference of GCS in two groups after 7 days operation(P<0.05). After operation, 43 patients survived and 14 died in standard large decompressive craniectomy group, while 53 patients survived and 9 died in standard large decompressive craniectomy and internal decompression group. According to Glasgow Outcome Score (GOS) 6 months later, 1 patients recovered well, 10 patients had moderate disability, 13 patients had severe disability and 19 patients were in a vegetative state in standard large decompressive craniectomy group, while 4 patients recovered well, 16 patients had moderate disability, 23 patients had severe disability and 10 patients were in a vegetative state in standard large decompressive craniectomy and internal decompression group. The later operation can decrease mortality and disability of patients significantly than the former operation (P<0.05). Furthermore, the standard large decompressive craniectomy and internal decompression operation can reduce post-operation complication significantly in acute massive infraction decompression in large area than the only standard large decompressive craniectomy operation (P<0.05). Conclusion Standard large decompressive craniectomy and internal decompression can significantly reduce the mortality and disability of patients with acute massive cerebral infarction in large area. Early surgical intervention and full decompression should be performed to save the lives of patients, reduce post-operation complications, improve prognosis and the quality of life.
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Received: 07 August 2017
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| ［1］冯怡墨，石滴坚，程泽沛，等．标准大骨瓣减压联合颞肌切除术在治疗大面积脑梗死中的应用［J］．重庆医学， 2014， 43(22)：2873-2874,2878．
［2］王新德．各类脑血管疾病诊断要点［J］．中华神经科杂志， 1996， (6)：379-380． 没有
［3］刘佰运．规范开展大骨瓣开颅手术［J］ ．中华神经外科杂志， 2016， 32 (4)：336-337．
［4］Rahmanian A, Seifzadeh B, Razmkon A, et al. Outcome of decompressive craniectomy in comparison to nonsurgical treatment in patients with malignant MCA infarction ［J］. Springerplus, 2014, 3:115.
［5］刘陆．标准大骨瓣与传统去骨瓣减压术在颅脑损伤致大面积脑梗死患者治疗中的价值比较［J］．中国药物经济学， 2017， 12(4)：111-113．
［6］陈磊，王玉海，蔡学见，等． 重型、特重型颅脑外伤性脑梗死相关危险因素分析［J］． 中华神经外科杂志， 2011， 27(4)：387-390．
［7］李涛．去骨瓣减压术联合颞肌脑表面贴附术治疗老年大面积脑梗死患者22 例［J］．中国老年学杂志， 2012， 32 (18)：4023-4024．
［8］戴永建，刘岳，罗俊杰．标准大骨瓣减压术治疗大面积脑梗死疗效观察［J］．现代中西医结合杂志， 2015， 24(9) ：960-962．
［9］Bar M, Mikulik R, Skolouodik D, et al. Nation wide study of decompressive surgery for malignant supratentorial infraction in the Czech republic: utilization and outcome predictors ［J］. J Neurosurg, 2010, 113(4): 897-900.
［10］俞学斌，金国良，王晓明，等．大面积脑梗死的去骨瓣减压手术治疗疗效分析［J］．浙江创伤外科杂志， 2011， 16(5)：642-643．［11］Litofsky NS, Chin LS, Tang G, et al. The use of lobectomy in the management of severe closed-head trauma ［J］. Neurosurgery, 1994， 34(4): 628-632.
［12］刘文，刘佰运．梗死灶切除治疗重型颅脑外伤合并大面积脑梗死［J］．中国微侵袭神经外科杂志， 2005， 10 (12)：538-540．
［13］赵刚，孙继程，刘帅，等. 大骨瓣减压术加内减压术治疗急性大面积脑梗死30例的临床经验总结［J］．中国现代医生， 2015， 53 (24)：38-41．
［14］刘佰运，江基尧，张赛．外伤大骨瓣手术方法介绍［J］．中华神经外科杂志， 2008， 24 (2)：153-154．
［15］Stocchetti N，Maas AI．Tramnalic intracranial hypertension［J］. N Eng J Med, 2014， 370(22): 2121-2130.
［16］刘佰运．规范开展大骨瓣开颅手术［J］．中华神经外科杂志， 2016， 32 (4)：336-337．
［17］Carney N, Totten AM, O′Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition ［J］. Neurosurgery, 2017, 80(1):6-15.
［18］范左栩，盖世英，刘伟国．去骨瓣减压术治疗大面积脑梗死的预后影响因素分析［J］．浙江创伤外科， 2010， 15 (1)：121-123．
［19］刘相城． 大骨瓣减压手术治疗大面积脑梗死临床体会［J］．中外医学研究， 2014， 12（35）：142-143．
［20］张祥，王增亮，汪永新，等．标准大骨瓣减压术结合颅内压监测治疗大面积脑梗死的临床分析［J］．中国临床神经外科杂志， 2015，(8)：497-499．
［21］孙一睿，胡锦，周良辅．低温疗法对脑保护作用的研究进展［J］．中华神经外科杂志， 2016， 32 (11)：1182-1185． |
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