【摘要】 目的 探讨“双C形”去骨瓣减压术治疗大面积脑梗死的临床效果。方法 回顾性分析了2004年8月～2007年8月收治的30例大面积脑梗死病例，20例行标准大骨瓣减压术(标准组)，10例行“双C形”去骨瓣减压术(改良组)，以Barthel指数(BAI)和格拉斯哥预后(GOS)评分评定临床效果。结果 所有病人均获随访。术后1、6个月，两组病死率比较差异无显著性(P>0.05)，而BAI、GOS评分比较差异均有显著性(t=2.593～7.162，P<0.05)。结论 “双C形”去骨瓣减压术可以对皮质静脉减压，对大面积脑梗死病人是一种较好的手术选择。
【关键词】 脑梗死;减压术,外科;治疗结果
DOUBLECSHAPE DECOMPRESSIVE CRANIECTOMY FOR MASSIVE HEMISPHERIC INFARCTION CAI ENYUAN, BAI ZHIQIANG, DONG LING (Department of Neurosurgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China); [ABSTRACT] Objective To study effect of doubleCshape decompression craniectomy (DC) on massive hemispheric infarction. Methods From August 2004 to August 2007, 30 cases with massive cerebral infarction (MCI) were treated in our hospital, of which, 20 underwent standard DC, and 10 underwent doubleCshape DC (modified group). The clinical effect was assessed according to Barthel Index (BAI) and Glasgow Outcome Score (GOS). Results All the patients were followedup after operation. The case fatality of one and six months after surgery between the two groups did not show statistically different (P>0.05); but the difference of BAI and GOS between the two groups was significant (t=2.593-7.162,P<0.05). Conclusion DoubleCshape DC may decompress cortical vein, which is a better choice for therapy of massive cerebral infarction.
[KEY WORDS] Cerebral infarction; Decompression, surgical; Treatment outcome
大面积脑梗死一旦发生，因大范围脑水肿，颅内压增高，中线移位，最终可形成脑疝，病死率高达80%[1]。标准大骨瓣减压术能明显降低病人的病死率[2]。但是生存者中重残者、植物生存者占大部分。本文探讨大面积脑梗死病人行“双C形”去骨瓣减压术治疗的临床效果。
1 资料与方法
1.1 病例入选及排除标准
采用中华医学会全国脑血管病学术会议制定的脑血管疾病诊断要点中脑梗死的诊断标准。大面积脑梗死的诊断标准为：①CT或MRI扫描示梗死范围超过大脑中动脉(MCA)供血区的一半，或多支血管供血区梗死，即MCA+大脑前动脉(ACA)或大脑后动脉(PCA)区梗死;②CT或MRI扫描示局部脑肿胀，中线结构向对侧移位>5 mm，基底池和侧脑室受压; ③有意识障碍、肢体偏瘫或早期小脑幕裂孔疝的表现。排除标准：①年龄>70岁;②近期有心肌梗死、心力衰竭、慢性阻塞性肺疾病、糖尿病昏迷等内科疾病;③CT扫描示
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