本文選題：硬膜下積液　切入點：小骨窗　出處：《蚌埠醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：目的:外傷性硬膜下積液(traumatic subdural hydroma,TSH)是一種閉合性顱腦損傷。本研究通過腦室鏡輔助下小骨窗治療硬膜下積液,通過腦室鏡進入積液腔觀察積液包膜,并尋找活瓣形成的證據(jù);尋找積液形成新包膜及其囊壁新生血管出血促進積液發(fā)展的證據(jù);尋找積液局部炎癥反應促進積液形成及發(fā)展方面證據(jù);通過腦室鏡取活檢,進行病理分析尋找包膜形成原因,同時抽取硬膜下積液檢測炎癥標記物如白介素-6(interleukin-6,IL-6)、白介素-8(interleukin-8,IL-8)、腫瘤壞死因子-α(Tumor necrosis factor-α,TNF-α),并檢測相關蛋白含量及成分,同時抽取患者血液進行相應檢驗比較,進一步探討硬膜下積液的發(fā)病機制。方法:選取硬膜下積液病人經(jīng)嚴格排除標準篩選后符合手術指征的患者36例,對其進行CT等影像學檢查,并結合患者病史將其分為穩(wěn)定型17人,進展型19人。同時選取同期正常人19人作為正常組參照,對符合手術指征患者進行小骨窗開顱清除積液,并通過腦室鏡觀察積液腔,抽取積液作為標本,并剝?nèi)“に筒±?同時抽取此36名患者外周靜脈血,以及19名正常人外周靜脈血作為對照。采用相應檢查方法檢測標本中蛋白質(zhì)、IL-6、IL-8以及TNF-α的含量,并作相互比較。結果:(1)經(jīng)腦室鏡觀察,發(fā)現(xiàn)36例經(jīng)手術治療患者中7例術中發(fā)現(xiàn)硬膜下積液的漏口,其中少數(shù)類似活瓣狀,其余未見明顯類似結構。同時可經(jīng)腦室鏡觀察積液壁明顯布滿新生毛細血管,未見出血。(2)術中取包膜活檢,并經(jīng)病理檢查發(fā)現(xiàn)為薄層炎癥結締組織;(3)抽取積液經(jīng)生化檢驗,蛋白質(zhì)陽性,其濃度略高于腦脊液。(4)穩(wěn)定組和進展組血漿IL-6、IL-8以及TNF-α含量與正常對照組血漿其含量比較差異無統(tǒng)計學意義(P0.05)。(5)進展型病例組積液IL-6、IL-8以及TNF-α含量與患者本身靜脈血血漿IL-6、IL-8以及TNF-α含量相比濃度明顯偏高,其差異有統(tǒng)計學意義(P0.01),穩(wěn)定型卻無明顯差異。(6)硬膜下積液患者積液IL-6、IL-8、TNF-α水平相關性分析,結果顯示兩者存在相關性(r=0.416 P0.05)。(7)經(jīng)腦室鏡治療預后好,無復發(fā)病例。結論:經(jīng)本實驗觀察發(fā)現(xiàn),硬膜下積液的發(fā)病機制難以用單一學說解釋,其發(fā)病可能是在多種發(fā)病機制相互促進形成的。(1)通過腦室鏡觀察,少數(shù)病例發(fā)現(xiàn)類似單向活瓣,提示活瓣學說存在一定臨床證據(jù)。(2)通過腦室鏡觀察患者積液形成包膜存在毛細血管增生,并經(jīng)病理發(fā)現(xiàn)包膜為增生肉芽組織,提示積液存在經(jīng)由新生毛細血管滲出形成可能。(3)進展型患者積液水腫液蛋白含量升高,IL-6、IL-8、TNF-α濃度高于患者本身周圍血漿IL-6、IL-8、TNF-α濃度,提示積液水腫液局部炎癥反應旺盛,幾乎無全身反應,并存在局部炎癥反應促進積液周圍形成富含新生毛細血管包膜的可能。(4)患者血漿IL-6、IL-8、TNF-α濃度同正常對照組血漿其含量無差異,證明硬膜下積液患者不存在全身炎癥反應。(5)通過腦室鏡可以修補活瓣裂孔,可以直觀下剝離炎性包膜,局部抗炎治療。有選擇的對病人施行針對治療可能成為部分硬膜下積液病人治療及預防復發(fā)及發(fā)展的有效手段。
[Abstract]:Objective: traumatic subdural effusion (traumatic subdural, hydroma, TSH) is a kind of closed craniocerebral injury. This study by ventriculoscope assisted craniotomy for treatment of subdural effusion, effusion by ventriculoscope observation capsule into the cavity effusion, and find evidence to find valve formation; the formation of new wall effusion coating and neovascularization to promote the development of evidence of hemorrhage effusion; for effusion local inflammation promote effusion formation and development of evidence; through endoscopic biopsy and pathological analysis for capsule formation reasons, at the same time. Detection of inflammatory markers from subdural effusion such as interleukin -6 (interleukin-6, IL-6), interleukin -8 (interleukin-8, IL-8), tumor necrosis (Tumor necrosis factor alpha factor- alpha, alpha TNF-), and the detection and composition of protein content, while the corresponding blood extraction were compared, further explore the subdural effusion The pathogenesis of the disease. Methods: Patients with subdural effusion after strict screening criteria with 36 cases, the CT imaging and combining with the history will be divided into stable type 17, type 19. At the same time in 19 normal people were selected as normal group reference according to the surgical indications, patients with small bone window craniotomy evacuation of the effusion, effusion and cavity were observed by ventriculoscope, extraction fluid as specimens, and stripping envelope sent to pathology, and the extraction of 36 patients with peripheral venous blood and 19 peripheral venous blood of healthy people as control. The corresponding inspection method of protein. The specimens of IL-6, IL-8 and TNF- in alpha, and compared with each other. Results: (1) observed by ventriculoscope, found 36 cases of subdural effusion leakage found in patients in 7 cases, of which a similar valve shape, the rest was not obvious Similar structure. At the same time through the observation of ventriculoscope effusion wall was covered with new capillaries, no bleeding. (2) the envelope biopsy, and the pathological examination indicated that inflammation is a thin connective tissue; (3) extraction fluid through biochemical tests, protein positive, its concentration is higher than that of cerebrospinal fluid. (4) the stable group and progress the serum level of IL-6 IL-8 and TNF-, alpha content and the normal control group the plasma content had no significant difference (P0.05). (5) in case group IL-6 and TNF- alpha IL-8 effusion, content of the patient's own venous blood plasma IL-6, IL-8 and TNF- were significantly higher than the concentration of alpha, the difference was statistically significant (P0.01), but no significant difference between the stable type. (6) IL-8 subdural effusion, IL-6, correlation analysis between the levels of TNF-, results show that there is a correlation between the two (r=0.416 P0.05). (7) the prognosis of ventriculoscope treatment is good, no recurrence. Conclusion: by this The experimental observation that the pathogenesis of subdural effusion is difficult to use a single theory explanation, the incidence may be in the pathogenesis of a variety of mutual promotion form. (1) by endoscopic observation, a few cases found similar one-way valve, suggesting the presence of certain clinical evidence theory. The valve (2) formed by ventriculoscope coated capillary hyperplasia are observed patients with effusion, and pathologically found coating granulation tissue, suggesting that the presence of fluid through new capillary exudation formation may. (3) increased, in patients with effusion of edema fluid protein content of IL-6, IL-8, TNF- alpha concentration was higher than the patients themselves around the plasma IL-6, IL-8, TNF- concentrations, suggesting that the local inflammatory response strong edema fluid effusion and almost no systemic reactions and local inflammation effusion around the rich capillaries promote capsule formation possible. (4) IL-8 patients, plasma IL-6, TNF- concentrations in the same The normal control group was no difference in plasma, proof of subdural effusion is not present in patients with systemic inflammatory response. (5) by ventriculoscope can repair the valve hole, can directly release inflammatory capsule and topical anti-inflammatory treatment. Selected patients underwent the treatment may become part of the effective means of treatment and prevention of recurrence of patients with effusion and the development of subdural.

【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.15

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本文編號：1575756