【摘要】：目的：盡管中腦導(dǎo)水管支架植入術(shù)(aqueduct stent placement, ASP)作為一種治療腦積水的根治性手術(shù)已被大家所熟知,但是目前關(guān)于該術(shù)式仍然缺乏全面、詳細(xì)的報(bào)道,特別是在手術(shù)指征、手術(shù)入路以及臨床療效方面。本單位自2009年開展此術(shù)式以來,取得良好的臨床效果,本文旨在探索ASP的手術(shù)指征、技術(shù)及臨床療效。方法：根據(jù)病人的腦積水病理類型、磁共振特征以及術(shù)中發(fā)現(xiàn),自2009年2月到2014年4月,在中國人民解放軍總醫(yī)院神經(jīng)外科共有10例病人被判斷為適合接受中腦導(dǎo)水管支架植入術(shù)。我們回顧性分析這10例病人的臨床資料并總結(jié)該術(shù)式的手術(shù)指征、手術(shù)技術(shù)及臨床療效。結(jié)果：10例患者均在全麻下順利接受中腦導(dǎo)水管支架植入術(shù),年齡5個月～69歲,平均年齡38歲。8例因中腦導(dǎo)水管梗阻(aqueduct stenosis, AS)被診斷為梗阻性腦積水,病理原因包括腦室內(nèi)腫瘤(3例)、腦室內(nèi)囊蟲病(2例)導(dǎo)水管膜性梗阻(3例)。2例表現(xiàn)為孤立四腦室(trapped fourth ventricle, TFV),病理原因分別為Dandy-Walker畸形和分流管植入治療感染后腦積水。8例在內(nèi)鏡引導(dǎo)下完成中腦導(dǎo)水管支架植入；2例通過開顱手術(shù),在顯微鏡下完成中腦導(dǎo)水管支架植入。沒有手術(shù)相關(guān)的死亡情況發(fā)生。所有患者的臨床癥狀均較術(shù)前有所改善。平均隨訪27個月(1-51個月),未見中腦導(dǎo)水管梗阻復(fù)發(fā)。1例術(shù)后出現(xiàn)一過性動眼神經(jīng)麻痹,3周后逐漸緩解。1例導(dǎo)水管支架在保持通暢在位4年后出現(xiàn)支架移位,內(nèi)鏡下取出移位支架并行ETV及中腦導(dǎo)水管成形術(shù)后,該患者術(shù)后恢復(fù)良好。結(jié)論：不管是內(nèi)鏡下還是開顱手術(shù),中腦導(dǎo)水管支架植入術(shù)在技術(shù)上可行,而且對特定的病人有效。
[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.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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本文編號：2343329