本文選題：正常顱壓腦積水 + 腦室腹腔分流術(shù)　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 正常顱壓腦積水(Normal pressure hydrocephalus, NPH)是一種腦室擴(kuò)大而腦脊液壓力正常的腦積水,臨床癥狀主要有步態(tài)不穩(wěn)、進(jìn)行性癡呆和尿失禁。分流術(shù)是改善正常顱壓腦積水病人癥狀的主要治療方法。本研究旨在對腦室腹腔分流術(shù)(ventriculoperitoneal shunts, V-P分流術(shù))和腰大池腹腔分流術(shù)(Lumboperitoneal shunts, L-P分流術(shù))對正常顱壓腦積水患者的癥狀改善,預(yù)后,以及并發(fā)癥進(jìn)行比較分析。 方法 回顧性分析本科于2014年1月至2014年8月間收治的正常顱壓腦積水患者54例,按手術(shù)方式分為V-P分流組42例和L-P分流組12例。平均隨訪8-14個(gè)月,記錄癥狀改善、并發(fā)癥和GOS預(yù)后評分情況。用統(tǒng)計(jì)學(xué)方法進(jìn)行比較分析,p0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果 共收入符合條件的患者54例,男性35例,女性19例。平均年齡58.2±12.6歲,平均隨訪10.87±1.92個(gè)月。其中特發(fā)性13例(24.1%),外傷后18例(33.3%),蛛網(wǎng)膜下腔出血后14例(25.9%),腦腫瘤術(shù)后4例(7.4%),腦出血術(shù)后5例(9.3%)。兩組的性別、年齡、隨訪時(shí)間、病因構(gòu)成無統(tǒng)計(jì)學(xué)差異。V-P分流組和L-P分流組步態(tài)不穩(wěn)的改善率分別為58.3%和54.5%,p=0.824；進(jìn)行性癡呆的改善率為57.1%和60.0%,p=0.872；尿失禁改善率分別為41.4%和44.4%,p=0.871,無顯著差異。V-P分流組術(shù)后出現(xiàn)堵管4例(9.5%),感染3例(7.1%),顱內(nèi)血腫1例(2.4%),癲癇2例(4.8%)。L-P分流組術(shù)后出現(xiàn)堵管2例(16.7%),較V-P分流組比例多,但無顯著差異p=0.862。兩組的GOS預(yù)后評分也沒有統(tǒng)計(jì)學(xué)差異p=0.410。 結(jié)論 V-P分流術(shù)和L-P分流術(shù)均能有效地改善正常顱壓腦積水的癥狀,兩者的改善率沒有顯著差異；V-P分流組發(fā)生了分流管堵塞、感染、顱內(nèi)血腫以及癲癇等并發(fā)癥,而L-P分流組更易發(fā)生分流管堵塞,但差異不顯著；兩者的預(yù)后評分也沒有顯著區(qū)別。L-P分流術(shù)可跟V-P分流術(shù)一樣,作為正常顱壓腦積水患者的常規(guī)治療方法。
[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 鹵12.6 years and the mean follow-up was 10.87 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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