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目的探讨双侧瞳孔散大的外伤性脑疝的手术效果和影响因素。方法67例双侧瞳孔散大的外伤性脑疝患者按原发损伤类型分组并接受手术治疗,于术后半年进行格拉斯哥预后评分(GOS)。结果全组恢复良好3例,中残10例,重残9例,植物生存10例,死亡35例。其中,硬膜外血肿组预后最好,弥漫性脑肿胀组最差,其差异有统计学意义(P＜0．05)。结论双侧瞳孔散大的外伤性脑疝手术疗效与脑原发损伤类型密切相关,硬膜外血肿所致的晚期脑疝应积极手术治疗,患者预后较佳；急性弥漫性脑肿胀所致晚期脑疝手术意义不大；部分脑挫伤和(或)硬膜下血肿导致的晚期脑疝患者经手术治疗仍能够挽救生命。另外,快速准确的术前诊断、恰当的术式选择和围手术期处理是救治成功的必要保证。
Objective To investigate the surgical effect and influencing factors of bilateral mydriatic traumatic brain hernia. Methods Sixty-seven patients with bilateral mydriatic traumatic brain hernias were grouped according to the primary injury type and were surgically treated. The Glasgow Outcome Scale (GOS) was performed six months after surgery. Results The whole group recovered well in 3 cases, 10 cases of disability, 9 cases of severe disability, 10 cases of plant survival and 35 cases of death. Among them, epidural hematoma group had the best prognosis, diffuse brain swelling group was the worst, the difference was statistically significant (P <0.05). Conclusions The curative effect of traumatic brain hernia with bilateral mydriasis is closely related to the type of primary brain injury. The advanced brain herniation caused by epidural hematoma should be treated actively and the prognosis is good. The acute stage of diffuse brain swelling Herniation surgery is of little significance; some brain contusion and / or subdural hematoma caused by the treatment of patients with advanced hernia can still save lives. In addition, rapid and accurate preoperative diagnosis, appropriate surgical procedures and perioperative management are the necessary guarantees for successful treatment.