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目的探讨大面积脑梗死伴发脑疝的外科手术治疗原则及疗效。方法本组12例患者,男8例,女4例,年龄49～75岁,左侧半球大面积梗死者7例,右侧5例;手术前GCS评分大于8分4例,5～8分7例,小于5分1例;其中11例一侧瞳孔散大,1例双侧瞳孔散大;所有患者均行去骨瓣减压术及硬膜扩大修补术。结果本组术后存活9例,占75%;3例死亡,占25%。随访6个月,在随访期内无死亡病例,其中GOS评分4分3例,3分5例,2分1例。结论去骨瓣减压术是大面积脑梗死伴发脑疝形成患者的一种有效治疗方法,它能大大降低患者的病死率和致残率,提高患者的生活质量。
Objective To investigate the surgical treatment principle and curative effect of large area cerebral infarction with cerebral hernia. Methods The group of 12 patients, 8 males and 4 females, aged 49 to 75 years old, left hemisphere large infarcts in 7 cases, right 5 cases; GCS before surgery more than 8 points in 4 cases, 5 to 8 points 7 cases, less than 1 in 5 cases; 11 cases of one side of the mydriasis, 1 case of bilateral mydriasis; all patients underwent decompressive craniectomy and dilatation repair. Results The group survived in 9 cases, accounting for 75%; 3 died, accounting for 25%. All the patients were followed up for 6 months. There were no deaths during the follow-up period. The GOS score was 4 in 3 cases, 3 in 5 cases, and 1 in 2 cases. Conclusion Bone decompression is an effective treatment for patients with large area cerebral infarction complicated by hernia. It can greatly reduce the mortality and morbidity of patients and improve the quality of life of patients.