两种术式应用可调压分流管治疗交通性脑积水疗效和安全性评估

发布时间：2018-02-27 07:07

本文关键词： 可调压分流管腰大池腹腔分流术脑室腹腔分流术并发症交通性脑积水疗效　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：回顾分析脑室-腹腔分流术及腰大池-腹腔分流术均在应用可调压分流管情况下,治疗交通性脑积水的疗效,两种术式安全性评估,及分流术中阀门的初始分流压力选择。方法：2010年12月至2013年12月在大连医科大学神经外科手术治疗的63例交通性脑积水患者,且排除肿瘤、先天性畸形、中脑导水管狭窄等引起的梗阻性脑积水(颅脑外伤后脑积水8例为,脑出血术后脑积水21例,颅内占位术后脑积水4例,其他特发性脑积水30例)。临床症状包括头痛、认知障碍、走路不稳、小便失禁、记忆力减退、昏迷,均经影像学检查明确诊断脑积水。根据患者及家属意愿行侧脑室-腹腔分流术(VPS)组38例,行腰大池-腹腔分流术(LPS)组25例。均选用法国索菲萨可无创体外调压分流管系统。术后观察患者症状和影像学改善情况,根据情况再次调整压力,最终无低颅内压的过度分流出现。分析两组患者疗效,比较两组患者术后并发症发生率差异的显著性。计数资料采用X2检验,P0.05为有差异,有统计学意义。结果：术后随访时间3-24个月,60例患者行影像学复查均可见脑室扩张情况减轻或消失,临床症状减轻或消失,2例患者影像学复查均可见脑室扩张情况减轻,但临床症状未见改善。LPS组临床有效20例(80%),并发症发生4例,发生率为16%。VPS组临床有效26例(68.4%),并发症共13例,发生率为34.2%。LPS与VPS治疗交通性脑积水总体有效率比较,术后初期LPS组因为并发症发生率明显低于VPS组,有效率明显高于VPS组,中后期有效率均略高于VPS组,但同期两两比较差异无统计学意义。两组总体并发症VPS组明显高于LPS组,但两者比较差别无统计学意义。VPS组6周内并发症为23%,而LPS组只出现1例,两者比较差别有统计学意义。LPS组远期并发症为12%,VPS组为11%,两组同期比较,差别无统计学意义。63例患者术后共调压82次,平均1.3次,调压比例29例(46%),最多5次,最后压力90-110mnH2035例(55%),最终压力比术中腰穿测得压力低20%48例(76%)两组患者均未因过度分流或分流不足而出现并发症。结论：采用LPS与VPS两种术式治疗交通性脑积水均达到良好疗效。LPS和VPS相比,早期并发症发生率低,有效避免脑组织穿刺引起的脑出血、脑损伤及继发性癫痫。近端及远端均以穿刺置管,手术操作时间交短,达到了微创的目的,近期疗效显著。同时体外可调压分流管的应用,可根据患者影像学检查情况及症状,术后多次无创调整分流管压力,针对个体差异,达到满意疗效,并且有效避免了过度分流或分流不足的并发症。
[Abstract]:Objective: to retrospectively analyze the efficacy and safety of ventriculoperitoneal shunt and lumbar cistern shunt in the treatment of communicating hydrocephalus. Methods: from December 2010 to December 2013, 63 patients with communicating hydrocephalus were treated by neurosurgery in Dalian Medical University. Obstructive hydrocephalus caused by stenosis of mesencephalic aqueduct (8 cases of hydrocephalus after craniocerebral trauma, 21 cases of hydrocephalus after cerebral hemorrhage, 4 cases of hydrocephalus after intracranial occupying, 30 cases of other idiopathic hydrocephalus). Cognitive impairment, unstable walking, urinary incontinence, memory loss and coma were all diagnosed by imaging examination. According to the wishes of patients and their families, 38 patients were treated with VPSs. Twenty-five patients in the LPSgroup underwent lumbar cistern and celiac shunt. All of them were treated with a non-invasive extracorporeal pressure regulating shunt system. The patients' symptoms and imaging improvement were observed after operation, and the pressure was adjusted again according to the situation. Finally, there was no excessive shunt with low intracranial pressure. The curative effect of the two groups was analyzed, and the difference in the incidence of postoperative complications between the two groups was compared. The counting data were compared by using X2 test (P0.05). Results: during the follow-up period of 3 to 24 months, all the 60 patients underwent imaging examination showed that the ventricular dilatation was alleviated or disappeared, the clinical symptoms were relieved or disappeared, and the ventricular dilatation was alleviated in 2 cases. But the clinical symptoms were not improved. In the LPS group, 20 cases were effective, 4 cases were complications, the incidence rate was 68.4% in the 16.VPS group, and 13 cases were the complications. The overall effective rate was 34.2.LPS and VPS in the treatment of communicating hydrocephalus. The incidence of complications in LPS group was significantly lower than that in VPS group, the effective rate was significantly higher in LPS group than in VPS group, and the effective rate in middle and late stage was slightly higher than that in VPS group, but there was no significant difference between the two groups in the same period. The overall complication rate in VPS group was significantly higher than that in LPS group. However, there was no significant difference between the two groups. The complications in VPS group were 23% within 6 weeks, while only one case appeared in LPS group. The long-term complications in LPS group were significantly higher than that in VPS group (n = 12, n = 11), and there was a significant difference between the two groups in the same period. The difference was not statistically significant in 63 patients (82 times, 1.3 times on average), and 29 cases (46 times, 5 times). The final pressure was 90-110mnH2035 cases, and the final pressure was 20H lower than that measured by lumbar puncture. (76 cases) neither of the two groups had complications due to excessive shunt or shunt insufficiency. Conclusion: both LPS and VPS procedures can be used to treat communicating hydrocephalus. Good efficacy. Compared with VPS, The incidence of early complications was low, and it was effective to avoid cerebral hemorrhage, brain injury and secondary epilepsy caused by puncture of brain tissue. The proximal and distal ends were inserted by puncture, the operation time was short, and the purpose of minimally invasive operation was achieved. At the same time, the application of extracorporeal adjustable pressure shunt tube can adjust the pressure of shunt tube many times after operation according to the imaging examination and symptom of the patient, aiming at the individual difference, so as to achieve satisfactory curative effect. And it effectively avoids the complications of excessive shunt or insufficient shunt.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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