本文關鍵詞： 可調壓分流管 腰大池腹腔分流術 腦室腹腔分流術 并發(fā)癥交通性腦積水 療效　出處：《大連醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：回顧分析腦室-腹腔分流術及腰大池-腹腔分流術均在應用可調壓分流管情況下,治療交通性腦積水的療效,兩種術式安全性評估,及分流術中閥門的初始分流壓力選擇。方法：2010年12月至2013年12月在大連醫(yī)科大學神經外科手術治療的63例交通性腦積水患者,且排除腫瘤、先天性畸形、中腦導水管狹窄等引起的梗阻性腦積水(顱腦外傷后腦積水8例為,腦出血術后腦積水21例,顱內占位術后腦積水4例,其他特發(fā)性腦積水30例)。臨床癥狀包括頭痛、認知障礙、走路不穩(wěn)、小便失禁、記憶力減退、昏迷,均經影像學檢查明確診斷腦積水。根據(jù)患者及家屬意愿行側腦室-腹腔分流術(VPS)組38例,行腰大池-腹腔分流術(LPS)組25例。均選用法國索菲薩可無創(chuàng)體外調壓分流管系統(tǒng)。術后觀察患者癥狀和影像學改善情況,根據(jù)情況再次調整壓力,最終無低顱內壓的過度分流出現(xiàn)。分析兩組患者療效,比較兩組患者術后并發(fā)癥發(fā)生率差異的顯著性。計數(shù)資料采用X2檢驗,P0.05為有差異,有統(tǒng)計學意義。結果：術后隨訪時間3-24個月,60例患者行影像學復查均可見腦室擴張情況減輕或消失,臨床癥狀減輕或消失,2例患者影像學復查均可見腦室擴張情況減輕,但臨床癥狀未見改善。LPS組臨床有效20例(80%),并發(fā)癥發(fā)生4例,發(fā)生率為16%。VPS組臨床有效26例(68.4%),并發(fā)癥共13例,發(fā)生率為34.2%。LPS與VPS治療交通性腦積水總體有效率比較,術后初期LPS組因為并發(fā)癥發(fā)生率明顯低于VPS組,有效率明顯高于VPS組,中后期有效率均略高于VPS組,但同期兩兩比較差異無統(tǒng)計學意義。兩組總體并發(fā)癥VPS組明顯高于LPS組,但兩者比較差別無統(tǒng)計學意義。VPS組6周內并發(fā)癥為23%,而LPS組只出現(xiàn)1例,兩者比較差別有統(tǒng)計學意義。LPS組遠期并發(fā)癥為12%,VPS組為11%,兩組同期比較,差別無統(tǒng)計學意義。63例患者術后共調壓82次,平均1.3次,調壓比例29例(46%),最多5次,最后壓力90-110mnH2035例(55%),最終壓力比術中腰穿測得壓力低20%48例(76%)兩組患者均未因過度分流或分流不足而出現(xiàn)并發(fā)癥。結論：采用LPS與VPS兩種術式治療交通性腦積水均達到良好療效。LPS和VPS相比,早期并發(fā)癥發(fā)生率低,有效避免腦組織穿刺引起的腦出血、腦損傷及繼發(fā)性癲癇。近端及遠端均以穿刺置管,手術操作時間交短,達到了微創(chuàng)的目的,近期療效顯著。同時體外可調壓分流管的應用,可根據(jù)患者影像學檢查情況及癥狀,術后多次無創(chuàng)調整分流管壓力,針對個體差異,達到滿意療效,并且有效避免了過度分流或分流不足的并發(fā)癥。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1

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