张雄新

[摘 要] 目的：分析大型脑膜瘤术后血肿形成原因，并探讨防治措施，为大型脑膜瘤术后血肿发生率的控制提供参考依据。 方法：回顾性分析我院2009年9月—2014年9月收治的95例行手术治疗的大型脑膜瘤患者资料，观察其术后血肿发生率，结合相关文献，分析大型脑膜瘤术后血肿的发生原因，探讨防治策略。 结果：共有10例患者发生术后血肿，发生率10.5%。术后发生血肿患者无1例痊愈，其轻残率、死亡率均显著高于术后未发生血肿的患者，差异有统计学意义（P<0.05）。 结论：大型脑膜瘤术后血肿的发生对患者预后可造成明显不良影响，针对肿瘤较大、术中止血不彻底等血肿形成原因，完善术前检查、术中操作、术后管理等各项环节是降低术后血肿发生率、保证手术效果、改善患者预后的关键。

[关键词] 大型脑膜瘤；术后血肿；原因；防治

中图分类号：R739.91 文献标识码：B 文章编号：2095-5200（2016）04-041-03

DOI：10.11876/mimt201604016

A study of the cause and prevention of hematoma after large meningiomas surgery ZHANG Xiongxin. （Departmen of Neurosurgical，Yulin Hospital of Traditional Chinese Medicine，Yulin 719000，China）

[Abstract] Objective： To analyze the cause of hematoma after large meningiomas surgery and explore its prevention so as to provide reference for controlling the incidence of hematoma. Methods： An analysis of the information of the 95 patients hospitalized from September， 2009 to September， 2014 who had underwent surgeries was made and the incidence of hematoma was calculated. Referring to relevant literature， the cause of hematoma after large meningiomas surgery was discussed and precautions were explored. Results： A total of 10 patients suffered hematoma after surgery， the incidence rate being 10.5%. Of the patients who suffered hematoma， not a single one recovered. The mild disability rate and morality were both remarkably higher than those of the patients who did not suffer hematoma. The difference was statistically significant（P<0.05）. Conclusions： Hematoma after large meningiomas surgery can exert a bad influence on patients. To deal with causes such as big tumor and incomplete hemostasis during operation， the key lies in reducing the rate of hematoma after surgery， ensuring surgical effect and ameliorating prognosis through measures such as improving pre-surgery check， operation during surgery， and management after surgery.

[Key words] large meningiomas；hematoma after surgery；cause；prevention

大型脑膜瘤具有生长缓慢、肿瘤体积较大、占位效应明显等特征，可造成周围正常的神经及血管移位、推压、压迫，引发相应临床症状[1]。手术切除是大型脑膜瘤治疗的首选方案，但由于瘤体较大，术中暴露、手术操作均较为困难，且术后颅内压迅速下降，加之手术时间较长、残留瘤腔较大，往往导致脑组织塌陷明显，桥静脉受到严重牵拉与撕扭，术后硬膜外血肿、瘤腔积血、硬膜下血肿等并发症发生率较高，不仅影响了手术效果，还对患者生存质量带来了巨大威胁[2]。多篇文献报道，大型脑膜瘤术后血肿发生率接近10%[3]，因此，对我院2009年9月—2014年9月收治的95例行手术治疗的大型脑膜瘤患者进行回顾性分析，以明确术后血肿发生的原因，实施科学合理的围术期防治方案，降低血肿发生风险。

1 一般资料

95例大型脑膜瘤患者中男23例，女72例，年龄18～72岁，平均（42.95±8.14）岁，病程5个月～9年，平均（1.83±0.92）年，瘤体直径5.2～9.4 cm，平均（6.42±1.83）cm；……