脑室腹腔分流术和腰大池腹腔分流术对正常颅压脑积水的疗效分析

发布时间：2018-04-27 15:24

本文选题：正常颅压脑积水 + 脑室腹腔分流术　；参考：《浙江大学》2015年硕士论文

【摘要】：目的正常颅压脑积水(Normal pressure hydrocephalus, NPH)是一种脑室扩大而脑脊液压力正常的脑积水,临床症状主要有步态不稳、进行性痴呆和尿失禁。分流术是改善正常颅压脑积水病人症状的主要治疗方法。本研究旨在对脑室腹腔分流术(ventriculoperitoneal shunts, V-P分流术)和腰大池腹腔分流术(Lumboperitoneal shunts, L-P分流术)对正常颅压脑积水患者的症状改善,预后,以及并发症进行比较分析。方法回顾性分析本科于2014年1月至2014年8月间收治的正常颅压脑积水患者54例,按手术方式分为V-P分流组42例和L-P分流组12例。平均随访8-14个月,记录症状改善、并发症和GOS预后评分情况。用统计学方法进行比较分析,p0.05有统计学意义。结果共收入符合条件的患者54例,男性35例,女性19例。平均年龄58.2±12.6岁,平均随访10.87±1.92个月。其中特发性13例(24.1%),外伤后18例(33.3%),蛛网膜下腔出血后14例(25.9%),脑肿瘤术后4例(7.4%),脑出血术后5例(9.3%)。两组的性别、年龄、随访时间、病因构成无统计学差异。V-P分流组和L-P分流组步态不稳的改善率分别为58.3%和54.5%,p=0.824；进行性痴呆的改善率为57.1%和60.0%,p=0.872；尿失禁改善率分别为41.4%和44.4%,p=0.871,无显著差异。V-P分流组术后出现堵管4例(9.5%),感染3例(7.1%),颅内血肿1例(2.4%),癫痫2例(4.8%)。L-P分流组术后出现堵管2例(16.7%),较V-P分流组比例多,但无显著差异p=0.862。两组的GOS预后评分也没有统计学差异p=0.410。结论 V-P分流术和L-P分流术均能有效地改善正常颅压脑积水的症状,两者的改善率没有显著差异；V-P分流组发生了分流管堵塞、感染、颅内血肿以及癫痫等并发症,而L-P分流组更易发生分流管堵塞,但差异不显著；两者的预后评分也没有显著区别。L-P分流术可跟V-P分流术一样,作为正常颅压脑积水患者的常规治疗方法。
[Abstract]:Purpose Normal pressure hydrocephalus (NPHs) is a kind of hydrocephalus with ventricular dilation and normal cerebrospinal fluid pressure. The main clinical symptoms are gait instability, progressive dementia and urinary incontinence. Shunt is the main method to improve the symptoms of patients with normal intracranial pressure hydrocephalus. The purpose of this study was to compare the symptoms, prognosis, and complications of ventricular and peritoneal shuntsand Lumboperitoneal shunts. between ventriculoperitoneal shunts( V-P) and Lumboperitoneal shunts (L-P) in patients with normal intracranial pressure hydrocephalus. Method Fifty-four patients with normal intracranial pressure hydrocephalus admitted from January 2014 to August 2014 were divided into V-P shunt group (n = 42) and L-P shunt group (n = 12). The average follow-up was 8-14 months, and the improvement of symptoms, complications and GOS prognosis score were recorded. There was statistical significance in comparing and analyzing p0.05 with statistical method. Result There were 54 eligible patients, 35 males and 19 females. The mean age was 58.2 卤12.6 years and the mean follow-up was 10.87 卤1.92 months. Among them, 13 cases had idiopathic tumor, 18 cases had 33.3%, 14 cases had subarachnoid hemorrhage, 4 cases had brain tumor, 5 cases had postoperative cerebral hemorrhage. Sex, age, follow-up time of the two groups, The improvement rate of gait instability in V-P shunt group and L-P shunt group was 58.3% and 54.5% respectively, the improvement rate of progressive dementia was 57.1% and 60.0p 0.872.The improvement rate of urinary incontinence was 41.4% and 44.4p0.871respectively. There were 4 cases with occluded tube, 3 cases with infection, 1 case with intracranial hematoma and 2.4%, 2 cases with epilepsy, 2 cases with occlusion and 16.7T after operation, which was more than that in V-P shunt group. But there was no significant difference between them. There was no significant difference in GOS prognostic scores between the two groups. Conclusion Both V-P shunt and L-P shunt can effectively improve the symptoms of normal intracranial pressure hydrocephalus. There is no significant difference in the improvement rate between the two groups. The V-P shunt group has complications such as shunt tube blockage, infection, intracranial hematoma and epilepsy. However, L-P shunt group is more prone to shunt obstruction, but the difference is not significant, and the prognostic score of L-P shunt group is not significantly different. L-P shunt can be used as a routine treatment method for patients with normal intracranial pressure hydrocephalus, just like V-P shunt.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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