神經(jīng)內(nèi)鏡第三腦室底造瘺術(shù)和腦室腹腔分流術(shù)治療梗阻性腦積水的療效分析
發(fā)布時間：2019-05-18 09:28
【摘要】：背景:梗阻性腦積水是神經(jīng)外科常見疾病,大部分觀點認(rèn)為是由于先天性或后天性因素造成的腦脊液循環(huán)通路在第四腦室出口以上部位受阻,使腦脊液流入腦池或蛛網(wǎng)膜下腔的通路發(fā)生障礙所引起的病理現(xiàn)象。其特征是腦脊液過多的積聚,導(dǎo)致腦室擴大,顱內(nèi)壓增高,可伴隨繼發(fā)性腦實質(zhì)萎縮,從而引起一系列的臨床癥狀,影響病人的正常生活,嚴(yán)重時甚至危及生命。腦室腹腔分流(Ventriculo-peritoneal shunt VPS)是治療腦積水的傳統(tǒng)方法,具有手術(shù)簡單易行、治療效果較確切的特點,但并發(fā)癥發(fā)生率高、復(fù)發(fā)率高、遠(yuǎn)期預(yù)后差等局限性逐漸凸顯。近年來神經(jīng)內(nèi)鏡三腦室底造瘺術(shù)(Endoscopicthirdventriculostomy ETV)以其微創(chuàng)性以及最大程度模擬腦脊液生理循環(huán)的特點得到廣泛應(yīng)用和認(rèn)可成為治療梗阻性腦積水的重要治療手段之一。在梗阻性腦積水治療中,ETV是否較VPS更有優(yōu)勢,是值得探討的臨床問題。目的:比較ETV和VPS兩種手術(shù)方式治療梗阻性腦積水在癥狀緩解率、并發(fā)癥發(fā)生率、復(fù)發(fā)率、遠(yuǎn)期生活質(zhì)量有無顯著性差異。方法:通過回顧性研究和隨訪青島市市立醫(yī)院神經(jīng)外科2006-2015年行ETV和VPS的治療梗阻性腦積水患者,選取滿足納入標(biāo)準(zhǔn)的ETV組28例和VPS組32例,比較兩組手術(shù)癥狀緩解率、并發(fā)癥發(fā)生率、復(fù)發(fā)率和SF-36評分。結(jié)果:經(jīng)統(tǒng)計分析,兩組手術(shù)病人術(shù)后癥狀緩解率和并發(fā)癥發(fā)生率無顯著性差異,兩組手術(shù)病人術(shù)后復(fù)發(fā)率兩者差異有統(tǒng)計學(xué)意義,ETV組相比VPS組復(fù)發(fā)率更低(P0.05)。遠(yuǎn)期生活質(zhì)量SF-36評分在8個方面評分上兩組均比手術(shù)前明顯改善(P0.05),而且ETV組術(shù)后SF-36評分的生理功能、精神健康、軀體疼痛和總體健康4個維度均顯著優(yōu)于VPS組(P0.05)。結(jié)論:在梗阻性腦積水的治療中,采用ETV手術(shù)較VPS手術(shù)術(shù)后復(fù)發(fā)率低,遠(yuǎn)期生活質(zhì)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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1
本文編號：2479883
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前4條
1 曹文君;化前珍;王庸晉;畫研;王金勝;徐勇勇;;SF-36量表在中國老年人群中應(yīng)用的心理學(xué)特征測評[J];現(xiàn)代預(yù)防醫(yī)學(xué);2014年06期
2 朱曉波;郭魁;崔柏和;;側(cè)腦室腹腔分流術(shù)常見并發(fā)癥分析[J];吉林醫(yī)學(xué);2008年19期
3 李曉梅;段麗萍;萬崇華;周曾芬;潘家華;楊錚;張曉磬;;SF-36量表在測定慢性病患者生命質(zhì)量中的應(yīng)用考評[J];中國醫(yī)藥;2006年11期
4 劉榮海;生命質(zhì)量及其在慢性非傳染性疾病防治中的研究進(jìn)展[J];實用預(yù)防醫(yī)學(xué);2003年02期
，本文編號：2479883
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2479883.html
最近更新
教材專著
