【摘要】 目的 探讨外伤性迟发性大脑半球间纵裂血肿(DTISH)的发生机制、临床特点和治疗方法。方法回顾性分析1998年以来收治的24例外伤性大脑半球间纵裂血肿病人的临床特点和救治情况。结果 本组24例，19例因头痛进行性加重(其中伴不完全性下肢瘫3例，不全偏瘫1例，排尿困难2例)，GCS评分下降，复查CT发现DTISH;另5例在清除血肿及去骨瓣减压术中出现缓慢的脑膨出，术后复查颅脑CT发现DTISH。治愈22例，其中9例行开颅血肿清除，3例行钻孔引流，10例保守治疗;2例死于突发呼吸停止、脑中心疝。结论 本病早期症状和体征不严重，以进行性头痛加重，突发病情恶化，血肿对侧肢体单瘫或偏瘫，下肢重于上肢，排尿困难为其特点。开颅血肿清除或去骨瓣减压术中，脑组织缓慢膨出，应想到本病的可能性。CT动态观察，可以明确诊断。只要提高对本病的认识，早期发现，早期诊断，无论手术还是保守治疗效果均良好。
【关键词】 血肿,硬膜下,颅内;早期诊断;治疗结果
[ABSTRACT] Objective To investigate the mechanism, clinical features and therapy of delayed traumatic hematoma in longitudinal fissure (LF). Methods A retrospective analysis was done in 24 patients with hematoma in LF had been treated since 1998. Results Of the 24 cases, 19 presented as progressive headache, of which, three cases with incomplete paralysis of lower limbs, one with incomplete hemiparalysis, two with dysuria. GCS score decreased, CT review found hematoma in LF. The other five cases with the hematoma in LF were found after postoperative CT scaning of the head because of cephalocele during hematoma removal and boneflap decompression procedure for head injury. Cure was achieved in 22 cases, in which, nine underwent craniotomy hematoma removal, three trepanation and drill drainage, 10 received conservative treatment; two died of sudden respiratory arrest due to cerebral hernia. Conclusion The symptoms and signs of this condition are not obvious in the early stage, which characterized with progressive headache, sudden deterioration, paralysis or hemiplegia. Cephalocele during hematoma tremoval or boneflap decompression suggestive of this disease. The diagnosis can be confirmed by CT. Early therapy can achive a favourable result by either surgery or conservative therapy.
[KEY WORDS] Hematoma, subdural, intracranial; Early diagnosis; Treatment outcome
外伤性迟发性大脑半球间纵裂血肿(DTISH)临床少见，报道甚少[1]。1998年1月～2008年12月，我院神经外科共收治外伤性迟发性大脑半球间纵裂血肿24例，本文结合文献对其加以讨论，旨在提高对DTISH的诊治水平，降低DTISH病人的病残率和病死率，现总结分析如下。
1 临床资料
1.1 一般资料
本组24例，男20例，女4例;年龄20～65岁。致伤原因：交通事故伤20例，摔伤4例。全部伤者均于伤后2 h内完成首次CT检查，未发现大脑半球间纵裂血肿，但均有不同程度的脑挫裂伤，蛛网膜下隙出血，其中并发硬膜外血肿或脑表面硬膜下血肿8例，并发颅骨骨折9例。CT复查及病情：19例病人入院后出现头痛加重，恶心呕吐，其中表现为不完全性下肢瘫3例，不全偏瘫1例，排尿困难2例，GCS评分均下降，复查CT发现DTISH;另5例在清除血肿及去骨瓣减压术中出现缓慢的脑膨出，经探查同侧硬膜外、硬膜下无明显血肿后关颅，复查颅脑CT发现DTISH。
1.2 治疗方法与结果
本组行开颅血肿清除术9例，术中发现桥静脉或脑表面静脉撕裂有明显活动性出血者5例，大脑半球近中线处均有不同程度的脑挫裂伤，术后恢复良好。保守治疗15例，其中3例演变成为慢性硬膜下血肿行钻孔引流术治愈，2例突发呼吸停止抢救无效死亡;另10例恢复期反复腰穿治愈。
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