中脑导水管支架植入术的手术指征、手术技术及临床经验探索

发布时间：2018-11-19 20:22

【摘要】：目的：尽管中脑导水管支架植入术(aqueduct stent placement, ASP)作为一种治疗脑积水的根治性手术已被大家所熟知,但是目前关于该术式仍然缺乏全面、详细的报道,特别是在手术指征、手术入路以及临床疗效方面。本单位自2009年开展此术式以来,取得良好的临床效果,本文旨在探索ASP的手术指征、技术及临床疗效。方法：根据病人的脑积水病理类型、磁共振特征以及术中发现,自2009年2月到2014年4月,在中国人民解放军总医院神经外科共有10例病人被判断为适合接受中脑导水管支架植入术。我们回顾性分析这10例病人的临床资料并总结该术式的手术指征、手术技术及临床疗效。结果：10例患者均在全麻下顺利接受中脑导水管支架植入术,年龄5个月～69岁,平均年龄38岁。8例因中脑导水管梗阻(aqueduct stenosis, AS)被诊断为梗阻性脑积水,病理原因包括脑室内肿瘤(3例)、脑室内囊虫病(2例)导水管膜性梗阻(3例)。2例表现为孤立四脑室(trapped fourth ventricle, TFV),病理原因分别为Dandy-Walker畸形和分流管植入治疗感染后脑积水。8例在内镜引导下完成中脑导水管支架植入；2例通过开颅手术,在显微镜下完成中脑导水管支架植入。没有手术相关的死亡情况发生。所有患者的临床症状均较术前有所改善。平均随访27个月(1-51个月),未见中脑导水管梗阻复发。1例术后出现一过性动眼神经麻痹,3周后逐渐缓解。1例导水管支架在保持通畅在位4年后出现支架移位,内镜下取出移位支架并行ETV及中脑导水管成形术后,该患者术后恢复良好。结论：不管是内镜下还是开颅手术,中脑导水管支架植入术在技术上可行,而且对特定的病人有效。
[Abstract]:Objective: although mesencephalic aqueduct stent implantation (aqueduct stent placement, ASP) is well known as a radical operation for hydrocephalus, there are still few comprehensive and detailed reports on this procedure, especially in the indication of operation. Surgical approach and clinical efficacy. Since the operation was carried out in 2009, good clinical results have been obtained. The purpose of this article is to explore the indications, techniques and clinical effects of ASP. Methods: according to the pathological type of hydrocephalus, magnetic resonance imaging and intraoperative findings, from February 2009 to April 2014, A total of 10 patients in the Neurosurgery Department of the General Hospital of the Chinese people's Liberation Army (PLA) were judged to be suitable for the implantation of mesencephalic aqueduct stent. We retrospectively analyzed the clinical data of these 10 patients and summarized the surgical indications, surgical techniques and clinical efficacy. Results: all the 10 patients were successfully treated with stent implantation under general anesthesia, aged from 5 months to 69 years, with an average age of 38 years, and 8 patients were diagnosed as obstructive hydrocephalus due to (aqueduct stenosis, AS) of mesencephalic aqueduct obstruction. Pathological causes included intraventricular tumors (3 cases), intraventricular cysticercosis (2 cases), aqueductal membrane obstruction (3 cases) and solitary fourth ventricle (trapped fourth ventricle, TFV), (2 cases). The pathological reasons were Dandy-Walker malformation and shunt tube implantation in the treatment of post-infection hydrocephalus. Through craniotomy, 2 cases were implanted with mesencephalic aqueduct stent under microscope. No operation-related deaths occurred. The clinical symptoms of all patients were improved compared with those before operation. The mean follow-up period was 27 months (1-51 months). No recurrence of the obstruction of the aqueduct was found. Temporary oculomotor palsy was found in 1 case, and gradually relieved after 3 weeks. In 1 case, the stent was displaced after 4 years of patency. The patients recovered well after endoscopic removal of displaced stents and ETV and midbrain aqueduct angioplasty. Conclusion: mesencephalic aqueduct stent implantation is technically feasible and effective for specific patients, both endoscopic and craniotomy.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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