Wen L, Wang H, Wang F, Gong J B, Li G, Huang X, Zhan R Y, Yang X F
First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, PR China.
Brain Inj. 2011;25(13-14):1318-24. doi: 10.3109/02699052.2011.608214. Epub 2011 Sep 8.
Decompressive craniectomy is an important method for managing traumatic brain injury (TBI). At present, controversies about this procedure exist, especially about the optimum operative time for patients with TBI.
A prospective study was performed at the First Affiliated Hospital, College of Medicine, Zhejiang University. From January 2008 to December 2009, 25 patients who underwent early decompressive craniectomy were included in the study group, and 19 patients who underwent "late" decompressive craniectomy as a second-tier therapy for intracranial hypertension were included as a comparison group.
The 30-day mortality after the operation was 16% in the study group. The overall mortality rate was 20% at the 6-month follow-up. A total of 52% of the patients (13 patients) had good outcomes, and 7 patients remained in a severely disabled or vegetative state. In the comparison group, 4 patients died, and 12 had good outcomes at the 6-month follow-up. The remaining 3 patients had poor outcomes. The study group was well matched with the comparison group. However, the outcomes in the study group were not better than those in the comparison group, as evaluated by the 6-month GOS score.
Early decompressive craniectomy as a first-tier therapy for intracranial hypertension did not improve patient outcome when compared with "late" decompressive craniectomy for managing TBI.
去骨瓣减压术是治疗创伤性脑损伤（TBI）的重要方法。目前，关于该手术存在争议，尤其是TBI患者的最佳手术时机。
在浙江大学医学院附属第一医院进行了一项前瞻性研究。2008年1月至2009年12月，25例行早期去骨瓣减压术的患者纳入研究组，19例行“晚期”去骨瓣减压术作为颅内高压二线治疗的患者作为对照组。
研究组术后30天死亡率为16%。6个月随访时总死亡率为20%。共有52%的患者（13例）预后良好，7例仍处于严重残疾或植物人状态。对照组4例死亡，6个月随访时12例预后良好。其余3例预后较差。研究组与对照组匹配良好。然而，根据6个月的GOS评分评估，研究组的预后并不优于对照组。
与用于治疗TBI的“晚期”去骨瓣减压术相比，早期去骨瓣减压术作为颅内高压的一线治疗方法并不能改善患者预后。
