脑室镜辅助下小骨窗治疗硬膜下积液及积液炎症分析

发布时间：2018-03-06 17:17

本文选题：硬膜下积液　切入点：小骨窗　出处：《蚌埠医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:外伤性硬膜下积液(traumatic subdural hydroma,TSH)是一种闭合性颅脑损伤。本研究通过脑室镜辅助下小骨窗治疗硬膜下积液,通过脑室镜进入积液腔观察积液包膜,并寻找活瓣形成的证据;寻找积液形成新包膜及其囊壁新生血管出血促进积液发展的证据;寻找积液局部炎症反应促进积液形成及发展方面证据;通过脑室镜取活检,进行病理分析寻找包膜形成原因,同时抽取硬膜下积液检测炎症标记物如白介素-6(interleukin-6,IL-6)、白介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α),并检测相关蛋白含量及成分,同时抽取患者血液进行相应检验比较,进一步探讨硬膜下积液的发病机制。方法:选取硬膜下积液病人经严格排除标准筛选后符合手术指征的患者36例,对其进行CT等影像学检查,并结合患者病史将其分为稳定型17人,进展型19人。同时选取同期正常人19人作为正常组参照,对符合手术指征患者进行小骨窗开颅清除积液,并通过脑室镜观察积液腔,抽取积液作为标本,并剥取包膜送病理,同时抽取此36名患者外周静脉血,以及19名正常人外周静脉血作为对照。采用相应检查方法检测标本中蛋白质、IL-6、IL-8以及TNF-α的含量,并作相互比较。结果:(1)经脑室镜观察,发现36例经手术治疗患者中7例术中发现硬膜下积液的漏口,其中少数类似活瓣状,其余未见明显类似结构。同时可经脑室镜观察积液壁明显布满新生毛细血管,未见出血。(2)术中取包膜活检,并经病理检查发现为薄层炎症结缔组织;(3)抽取积液经生化检验,蛋白质阳性,其浓度略高于脑脊液。(4)稳定组和进展组血浆IL-6、IL-8以及TNF-α含量与正常对照组血浆其含量比较差异无统计学意义(P0.05)。(5)进展型病例组积液IL-6、IL-8以及TNF-α含量与患者本身静脉血血浆IL-6、IL-8以及TNF-α含量相比浓度明显偏高,其差异有统计学意义(P0.01),稳定型却无明显差异。(6)硬膜下积液患者积液IL-6、IL-8、TNF-α水平相关性分析,结果显示两者存在相关性(r=0.416 P0.05)。(7)经脑室镜治疗预后好,无复发病例。结论:经本实验观察发现,硬膜下积液的发病机制难以用单一学说解释,其发病可能是在多种发病机制相互促进形成的。(1)通过脑室镜观察,少数病例发现类似单向活瓣,提示活瓣学说存在一定临床证据。(2)通过脑室镜观察患者积液形成包膜存在毛细血管增生,并经病理发现包膜为增生肉芽组织,提示积液存在经由新生毛细血管渗出形成可能。(3)进展型患者积液水肿液蛋白含量升高,IL-6、IL-8、TNF-α浓度高于患者本身周围血浆IL-6、IL-8、TNF-α浓度,提示积液水肿液局部炎症反应旺盛,几乎无全身反应,并存在局部炎症反应促进积液周围形成富含新生毛细血管包膜的可能。(4)患者血浆IL-6、IL-8、TNF-α浓度同正常对照组血浆其含量无差异,证明硬膜下积液患者不存在全身炎症反应。(5)通过脑室镜可以修补活瓣裂孔,可以直观下剥离炎性包膜,局部抗炎治疗。有选择的对病人施行针对治疗可能成为部分硬膜下积液病人治疗及预防复发及发展的有效手段。
[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.

【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15

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