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目的分析伴有Labbe静脉损伤脑外伤的临床特点和临床治疗方案,为该病的治疗提供参考。方法回顾性分析取葛洲坝中心医院2013年7月至2015年4月收治的伴有Labbe静脉损伤的脑外伤手术患者37例的临床资料,分析其临床特点和治疗方案。结果 (1)术前情况:37例患者中,26例单侧瞳孔散大,11例双侧瞳孔散大。所有患者均在伤后6 h内接受CT扫描。(2)手术方式和术中情况:37例均实施开颅挫伤灶和血肿清除术,常规扩大翼点入路。在手术中,Labbe静脉8例主干彻底断裂、21例撕裂伤、8例血管壁钝挫伤。17例采取电凝阻断术治疗,不对血流动力学改变进行处理;20例采取静脉修复术治疗(6例血管壁受损较轻者用明胶海绵和止血纱贴止血,14例血管壁损伤严重者显微镜下吻合修补血管)。(3)术后情况:术后颅脑CT复查,17例出现脑水肿(10例为脑内血肿,7例为恶性脑肿胀行二次血肿清除术),其中10例为静脉阻断术治疗患者(6例迟发型脑内血肿,4例恶性脑肿胀保守治疗后再次行二次血肿清除术)5例好转,5例死亡;7例为静脉修复患者(4例迟发性脑内血肿,3例恶性脑肿胀再次手术治疗),4例好转,3例死亡。(4)术后并发症:除出现脑水肿的17例外,其他20例均出现并发症,主要为失语症、记忆力下降、偏瘫等,术后4周失语症和记忆力开始逐渐恢复,未见其他明显神经功能障碍。结论伴有Labbe静脉损伤的脑外伤手术临床存在瞳孔散大情况,临床治疗方法较多,预后差,术后并发症主要是失语症、记忆力下降等,建议给予针对性治疗,提高患者存活率。
Objective To analyze the clinical characteristics and clinical treatment of traumatic brain injury associated with Labbe’s venous injury, and to provide a reference for the treatment of this disease. Methods The clinical data of 37 patients with traumatic brain injury with Labbe’s vein injury admitted from July 2013 to April 2015 in Gezhouba Central Hospital were analyzed retrospectively. The clinical features and treatment were analyzed. Results (1) preoperative situation: 37 patients, 26 cases of unilateral mydriasis, 11 cases of bilateral mydriasis. All patients underwent CT scans within 6 h after injury. (2) surgical methods and intraoperative conditions: 37 cases were implemented craniotomy and hematoma removal surgery, the general expansion of pterional approach. During the operation, 8 cases of Labbe vein were completely broken, 21 cases of laceration and 8 cases of blunt trauma. Twenty-seven patients were treated by electrocoagulation and no hemodynamic changes were performed. Twenty patients underwent venous repair (6 patients with less damaged vessel wall, gelatin sponge and hemostatic gauze, and 14 vessel wall injury Severe under the microscope repair blood vessels). (3) postoperative condition: postoperative brain CT review, 17 cases of cerebral edema (10 cases of intracerebral hematoma, seven cases of malignant brain swelling secondary hematoma removal), of which 10 cases were treated by vein occlusion Five patients improved in five patients (six delayed intracerebral hematoma, four again treated with conservative treatment of malignant brain swelling), and five died. Seven patients received intravenous repair (four patients with delayed intracerebral hematoma, 3 cases of malignant brain swelling surgery again), 4 cases improved, 3 patients died. (4) Postoperative complications: In addition to cerebral edema in 17 cases, the other 20 cases showed complications, mainly aphasia, memory loss, hemiplegia, etc., after 4 weeks of aphasia and memory began to gradually recover, no other Obvious neurological dysfunction. Conclusions There are clinical manifestations of mydriasis in traumatic brain injury with Labbe’s venous injury. There are many clinical treatments, poor prognosis, and postoperative complications are mainly aphasia and memory loss. It is suggested to give targeted treatment to improve the survival rate of patients.