中文摘要：

目的比较双额、颞、顶去骨瓣减压和常规减压术治疗重型颅脑创伤致双侧瞳孔散大的临床效果。方法将2009年3月至2013年3月收治的70例重型颅脑创伤致双侧瞳孔散大患者随机均分为实验组（行双额、颞、顶去骨瓣减压术）和对照组（常规减压术），各35例，比较两组患者存活率以及术后进行格拉斯哥预后评分（GOS）和并发症发生率比较。结果①实验组35例患者中救治成功32例，成功率为91．4％，死亡3例，病死率为8．6％；对照组35例救治成功26例，成功率74．3％，死亡9例，病死率25．7％，两组患者救治成功率及病死率比较差异具有统计学意义（P〈0．05）；②术后对两组存活的患者随访6个月，进行GOS预后评分，发现实验组患者恢复良好率34．4％（11／32）明显高于对照组患者11．5％（3／26），且实验组患者术后并发症发生率较对照组患者更低，差异均有统计学意义（P〈0．05）。结论采用双额、颞、顶去骨瓣减压术治疗重型颅脑创伤致双侧瞳孔散大能有效提高患者生存率，并且对于减低患者高颅内压效果显著，值得临床推广应用。

英文摘要：

Objective To compare the clinical efficacy between bilateral hemicraniectomy and conventional decompression in treating se- vere traumatic brain injury with bilateral mydriasis. Methods Slected 70 cases severe traumatic brain injury patients with bilateral mydriasis ad- mitted to our hospital from March 2009 to March 2013 ,divided them into Control group（ given conventional decompression） and Experimental group （ given bilateral hemicraniectomy）, compared the treatment effect of two groups after treatment. Results （1）The treatment success rate and mortal- ity rate were 91.4% and 8.6% in experimental group,which were 74.3 % and 25.7% in control group, which were significant differences （ P 〈 0.05 ） ; （2）According to result of GOS followed for 6 months, the good recovery - rate of experimental group was higher than that of control group （ P 〈 0.05 ）, and the incidence of complications was lower in experimental group than that in control group （ P 〈 0. 05 ）. Conclusion Bilateral hemicraniectomy has a significant effects on treating severe traumatic brain injury with bilateral mydriasis ,which was worthy of clinical widely.