神经内镜第三脑室底造瘘术和脑室腹腔分流术治疗梗阻性脑积水的疗效分析

发布时间：2019-05-18 09:28

【摘要】：背景:梗阻性脑积水是神经外科常见疾病,大部分观点认为是由于先天性或后天性因素造成的脑脊液循环通路在第四脑室出口以上部位受阻,使脑脊液流入脑池或蛛网膜下腔的通路发生障碍所引起的病理现象。其特征是脑脊液过多的积聚,导致脑室扩大,颅内压增高,可伴随继发性脑实质萎缩,从而引起一系列的临床症状,影响病人的正常生活,严重时甚至危及生命。脑室腹腔分流(Ventriculo-peritoneal shunt VPS)是治疗脑积水的传统方法,具有手术简单易行、治疗效果较确切的特点,但并发症发生率高、复发率高、远期预后差等局限性逐渐凸显。近年来神经内镜三脑室底造瘘术(Endoscopicthirdventriculostomy ETV)以其微创性以及最大程度模拟脑脊液生理循环的特点得到广泛应用和认可成为治疗梗阻性脑积水的重要治疗手段之一。在梗阻性脑积水治疗中,ETV是否较VPS更有优势,是值得探讨的临床问题。目的:比较ETV和VPS两种手术方式治疗梗阻性脑积水在症状缓解率、并发症发生率、复发率、远期生活质量有无显著性差异。方法:通过回顾性研究和随访青岛市市立医院神经外科2006-2015年行ETV和VPS的治疗梗阻性脑积水患者,选取满足纳入标准的ETV组28例和VPS组32例,比较两组手术症状缓解率、并发症发生率、复发率和SF-36评分。结果:经统计分析,两组手术病人术后症状缓解率和并发症发生率无显著性差异,两组手术病人术后复发率两者差异有统计学意义,ETV组相比VPS组复发率更低(P0.05)。远期生活质量SF-36评分在8个方面评分上两组均比手术前明显改善(P0.05),而且ETV组术后SF-36评分的生理功能、精神健康、躯体疼痛和总体健康4个维度均显著优于VPS组(P0.05)。结论:在梗阻性脑积水的治疗中,采用ETV手术较VPS手术术后复发率低,远期生活质量高。
[Abstract]:Background: obstructive hydrocephalus is a common neurosurgical disease. Most of them believe that the cerebrospinal fluid circulation pathway caused by congenital or acquired factors is blocked above the exit of the fourth ventricle. A pathological phenomenon caused by an obstacle in the pathway of cerebrospinal fluid flowing into the cistern or subarachnoid space. It is characterized by excessive accumulation of cerebrospinal fluid, resulting in enlargement of ventricle and increase of intracranial pressure, which can be accompanied by secondary atrophy of brain parenchyma, resulting in a series of clinical symptoms, affecting the normal life of patients, and even endangering life in serious cases. Ventricular and abdominal shunt (Ventriculo-peritoneal shunt VPS) is a traditional method for the treatment of hydrocephalus, which has the characteristics of simple operation and accurate therapeutic effect, but the limitations such as high incidence of complications, high recurrence rate and poor long-term prognosis have gradually become prominent. In recent years, (Endoscopicthirdventriculostomy ETV) has been widely used and recognized as one of the important treatment methods for the treatment of obstructive hydrocephalus because of its minimally invasive and maximum simulation of cerebrospinal fluid physiological circulation. Whether ETV has more advantages than VPS in the treatment of obstructive hydrocephalus is a clinical problem worthy of discussion. Objective: to compare the remission rate of symptoms, the incidence of complications, recurrence rate and long-term quality of life between ETV and VPS in the treatment of obstructive hydrocephalus. Methods: the patients with obstructive hydrocephalus treated with ETV and VPS in neurosurgery department of Qingdao Municipal Hospital in 2006 were studied and followed up retrospectively. 28 patients in ETV group and 32 patients in VPS group who met the inclusion criteria were selected to compare the remission rate of surgical symptoms between the two groups. Incidence of complications, recurrence rate and SF-36 score. Results: there was no significant difference in postoperative symptom remission rate and complications rate between the two groups. There was significant difference in postoperative recurrence rate between the two groups. The recurrence rate of ETV group was lower than that of VPS group (P 0.05). The SF-36 score of long-term quality of life in both groups was significantly improved in 8 aspects compared with that before operation (P 0.05), and the physiological function and mental health of SF-36 score in ETV group. The four dimensions of body pain and overall health were significantly better than those in VPS group (P 0.05). Conclusion: in the treatment of obstructive hydrocephalus, the recurrence rate of ETV operation is lower than that of VPS operation, and the long-term quality of life is higher.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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