自体颅骨修补术后硬膜外/皮下积液的防治体会
Experience in the Management of Epidural and Subcutaneous Effusion after Autologous Cranioplasty
DOI: 10.12677/acrs.2024.122002, PDF,    科研立项经费支持
作者: 陈浩东, 郝泽林, 裘五四*, 杨文杰, 徐 炜, 徐路敏：杭州师范大学附属医院(杭州市第二人民医院)神经外科，浙江 杭州
关键词: 颅骨修补；自体骨；硬膜外积液；皮下积液；并发症；预后；Cranioplasty； Autologous Bone； Epidural Effusion； Subcutaneous Effusion； Complication； Prognosis
摘要: 通过回顾性分析4例自体颅骨修补术后出现硬膜外/皮下积液患者的临床资料和处理方式，总结修补后并发症发生原因，探讨自体颅骨修补术后出现硬膜外/皮下积液的原因及相应的防治措施。4例患者在自体颅骨修补术后均出现了硬膜外/皮下积液，经过一段时间的治疗后均已吸收，术后恢复情况可。皮下积液是颅骨修补后最常见的并发症之一，产生的原因也多种多样，结合查阅的相关文献，手术中的止血不充分、术中颅板和脑膜悬吊过深导致的脑脊液漏、手术部位的差异、自体颅骨的不当保存方式等多种因素等均是发生硬膜外/皮下积液的原因。
Abstract: All 4 patients developed epidural/subcutaneous effusion after autologous cranioplasty, which was absorbed after a period of treatment with good outcome. Subcutaneous effusion is one of the common complications after autologous cranioplasty. In adequate haemostasis during surgery, cerebrospinal fluid leakage due to appropriate suspension of dura, and differences in surgical sites are some of the reasons for the occurrence of epidural/subcutaneous effusion. The optimal autologous cranial bone preservation techniques, the appropriate suspension of dura and temporalis, effective haemostasis and internal environment homeostasis in perioprative period can reduce the incidence of epidural/subcutaneous effusions after autologous cranioplasty.
文章引用：陈浩东, 郝泽林, 裘五四, 杨文杰, 徐炜, 徐路敏. 自体颅骨修补术后硬膜外/皮下积液的防治体会[J]. 亚洲外科手术病例研究, 2024, 12(2): 7-11. https://doi.org/10.12677/acrs.2024.122002

参考文献

[1] Christianson, D., Seaman, S.C., Ray, E., Li, L., Zanaty, M., Lemoine, P., et al. (2023) The Adjustable Cranial Plate: A Novel Implant Designed to Eliminate the Need for Cranioplasty Surgery Following a Hemicraniectomy Operation. World Neurosurgery, 173, e306-e320. [Google Scholar] [CrossRef] [PubMed]
[2] Mele, C., Bassetto, A., Boetto, V., Nardone, A. and Pingue, V. (2022) Impact of Cranioplasty on Rehabilitation Course of Patients with Traumatic or Hemorrhagic Brain Injury. Brain Sciences, 13, Article 80. [Google Scholar] [CrossRef] [PubMed]
[3] Fan, M., Wang, Q., Sun, P., Zhan, S., Guo, P., Deng, W., et al. (2018) Cryopreservation of Autologous Cranial Bone Flaps for Cranioplasty: A Large Sample Retrospective Study. World Neurosurgery, 109, e853-e859. [Google Scholar] [CrossRef] [PubMed]
[4] 高翔. 冷冻保存自体颅骨行颅骨修补术56例临床分析[J]. 中华神经创伤外科电子杂志, 2018, 4(3): 148-150.
[5] 江竟成, 张超, 王瀚, 邓青山, 吴蛟, 罗鹏, 邱俊, 周世军, 陶裕川, 徐小平, 屈小琴, 向玉, 易勇. 自体颅骨修补术术前颅骨处理方式对修复效果的影响[J]. 临床外科杂志, 2021, 29(9): 821-823.
[6] 宋光太, 杨力军. 颅骨修补术后常见并发症原因分析及诊治体会[J]. 浙江创伤外科, 2019, 24(1): 9-10.
[7] 王湘, 黄浩, 王海全, 黄小龙, 胡齐. 自体颅骨、钛网与聚醚醚酮修补颅骨缺损的临床应用分析[J]. 临床和实验医学杂志, 2021, 20(15): 1643-1647.
[8] 刁云锋, 杨细平. 几种颅骨修补材料的临床应用及并发症防治[J]. 中国组织工程研究与临床康复, 2011, 15(16): 2985-2989.
[9] Mozaffari, K., Rana, S., Chow, A., Mahgerefteh, N., Duong, C., Sheppard, J.P., et al. (2022) Customized Polyetheretherketone (PEEK) Implants Are Associated with Similar Hospital Length of Stay Compared to Autologous Bone Used in Cranioplasty Procedures. Journal of the Neurological Sciences, 434, Article ID: 120169. [Google Scholar] [CrossRef] [PubMed]
[10] Ong, A.A., Manning, J.P., Vincent, A.G., Namin, A.W., Wang, W. and Ducic, Y. (2021) Cranioplasty. Facial Plastic Surgery, 37, 698-702. [Google Scholar] [CrossRef] [PubMed]
[11] Wang, S., et al. (2023) Malignant Cerebral Edema after Cranioplasty: A Case Report and Literature Review. Brain Injury, 1-7.
https://pubmed.ncbi.nlm.nih.gov/36625002/
[12] Alkhaibary, A., Alharbi, A., Alnefaie, N., Oqalaa Almubarak, A., Aloraidi, A. and Khairy, S. (2020) Cranioplasty: A Comprehensive Review of the History, Materials, Surgical Aspects, and Complications. World Neurosurgery, 139, 445-452. [Google Scholar] [CrossRef] [PubMed]
[13] 曾浩, 陈玉霞, 成泉江. 颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的原因及治疗策略[J]. 安徽医药, 2022, 26(2): 326-330.
[14] Nam, H.H., Ki, H.J., Lee, H.J. and Park, S.K. (2022) Complications of Cranioplasty Following Decompressive Craniectomy: Risk Factors of Complications and Comparison between Autogenous and Artificial Bones. Korean Journal of Neurotrauma, 18, 238-245. [Google Scholar] [CrossRef] [PubMed]
[15] 王彦伟. 颅脑术后皮下积液的临床分析[J]. 医药论坛杂志, 2014, 35(5): 98-99.
[16] 张晓泉. 超低温冰冻自体颅骨修补的临床应用[C]//中国医师协会、中国医师协会神经外科医师分会, 中国医师协会神经外科医师分会. 第十六届中国医师协会神经外科医师年会摘要集. 2022: 1.
[17] Zaed, I., Faedo, F., Chibbaro, S., Cannizzaro, D., Tomei, M., Servadei, F., et al. (2022) Prevalence of Postoperative Complications of Autologous and Heterologous Cranioplasty in the Pediatric Population: A Systematic Review of the Literature. Pediatric Neurosurgery, 57, 238-244. [Google Scholar] [CrossRef] [PubMed]
[18] Roblot, P., Belaroussi, Y., Peiffer-Smadja, N., Lafarge, X., Cotto, E., Colombat, M., et al. (2023) Effect of Microorganisms Isolated by Preoperative Osseous Sampling on Surgical Site Infection After Autologous Cranioplasty: A Single-Center Experience. Neurochirurgie, 69, Article ID: 101458. [Google Scholar] [CrossRef] [PubMed]

为你推荐