Clinical study of bilateral decompressive craniotomy for treating patients with double hedge severe craniocerebral injury / 中国医师进修杂志

ABSTRACT

Objective To investigate the clinical efficacy of bilateral decompressive craniotomy for treating the patients with double hedge severe craniocerebral injury (DHSCBI).Methods Sixty patients with DHSCBI were divided by random digits table method into treatment group and control group with 30 cases each.The treatment group was treated with bilateral decompressive craniotomy,while the control group was treated with traditional unilateral craniotomy.The acute brain swelling,incisional hernia,intracranial pressure of postoperative 1,3,7 d were observed and recorded.The patients were followed up for 3 months to evaluate the clinical efficacy.Results The incidence of acute brain swelling and incisional hernia in treatment group were 13.3％ (4/30) and 20.0％ (6/30),respectively,which were significantly lower than those in control group [56.7％ (17/30) and 63.3％ (19/30)] (P ＜0.01 ).The intracranial pressure of postoperative 1,3,7 d in treatment group [(21.34 ±3.05),(18.43 ±2.63),(15.52 ±2.21) mm Hg(1mm Hg =0.133 kPa)] were significantly lower than those in control group[ (31.21 ± 4.46),(29.13 ±4.16),(24.97 ±3.57) mm Hg] (P ＜0.05).The clinical efficacy in treatment group [53.3％ (16/30)] was significantly higher than that in control group [23.3％ (7/30)] (P ＜ 0.05 ).The mortality rate in treatment group [16.7％ (5/30)] was significantly lower than that in control group [40.0％(12/30)] (P ＜0.05).Conclusions Compared with traditional unilateral craniotomy,bilateral decompressive craniotomy can reduce the incidence of acute brain swelling and incisional hernia of DHSCBI patients,and have better prognosis.It is worthy of clinical application.