两种不同侧脑室穿刺位置手术治疗脑积水的疗效研究
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摘要
目的研究两种不同侧脑室穿刺位置行脑室-腹腔分流术治疗脑积水的疗效,以及对术后并发症的影响。方法采用侧脑室副三角区穿刺脑室-腹腔分流术治疗52例脑积水患者(副三角区穿刺组),另取侧脑室三角区穿刺行脑室-腹腔分流术47例患者为对照组。比较两组患者的术后并发症,以及术后1年与术前的美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分。结果副三角区穿刺组脑室端堵管、总并发症的发生率均明显低于对照组,差异有统计学意义(均P <0. 05);两组感染、出血和硬膜下积液发生率的差异无统计学意义。两组术后1年时的NIHSS评分均明显低于术前(均P <0. 05)。结论与侧脑室三角区穿刺比较,副三角区穿刺行脑室-腹腔分流术可降低脑室端相关并发症的发生率,有效改善临床症状,具有良好的治疗效果。
Objective To study the effect of ventriculoperitoneal shunt in the treatment of hydrocephalus at two different lateral ventricle puncture locations and its influence on postoperative complications. Methods 52 patients with hydrocephalus were treated by ventriculoperitoneal shunt through lateral ventricle paratriangle area puncture (paratriangle area puncture group),and 47 patients were treated by ventriculoperitoneal shunt through lateral ventricle triangle area puncture as control group. Postoperative complications were compared between the two groups,and the National Institutes of Health Stroke Scale (NIHSS) scores one year after surgery and before surgery were compared. Results The incidence of ventricular end occlusion and total complications in the paratriangular puncture group was significantly lower than that in the control group (P < 0. 05),and there was no significant difference in the incidence of infection,hemorrhage and subdural effusion between the two groups. The NIHSS score at 1 year after operation in both groups was significantly lower than that before operation (all P < 0. 05). Conclusion Compared with lateral ventricular triangle puncture,ventriculoperitoneal shunt through paratriangle puncture can reduce the incidence of ventricular end-related complications,effectively improve clinical symptoms,and has a good therapeutic effect.
Objective To study the effect of ventriculoperitoneal shunt in the treatment of hydrocephalus at two different lateral ventricle puncture locations and its influence on postoperative complications. Methods 52 patients with hydrocephalus were treated by ventriculoperitoneal shunt through lateral ventricle paratriangle area puncture (paratriangle area puncture group),and 47 patients were treated by ventriculoperitoneal shunt through lateral ventricle triangle area puncture as control group. Postoperative complications were compared between the two groups,and the National Institutes of Health Stroke Scale (NIHSS) scores one year after surgery and before surgery were compared. Results The incidence of ventricular end occlusion and total complications in the paratriangular puncture group was significantly lower than that in the control group (P < 0. 05),and there was no significant difference in the incidence of infection,hemorrhage and subdural effusion between the two groups. The NIHSS score at 1 year after operation in both groups was significantly lower than that before operation (all P < 0. 05). Conclusion Compared with lateral ventricular triangle puncture,ventriculoperitoneal shunt through paratriangle puncture can reduce the incidence of ventricular end-related complications,effectively improve clinical symptoms,and has a good therapeutic effect.
引文
[1]中华神经外科分会神经创伤专业组.中华创伤学会分会神经创伤专业组.颅脑创伤后脑积水诊治中国专家共识[J].中华神经外科杂志,2014,30:840.
[2]Parker SL,Mcgirt MJ,Murphy JA,et al.Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus:analysis of 12,589 consecutive cases from 287 US hospital systems[J].J Neurosurg,2015,122:443.
[3]杨坤,刘宏毅,邹元杰,等.侧脑室-腹腔分流术治疗正常压力脑积水[J].临床神经外科杂志,2012,9:101.
[4]徐岩,曾光,孙飞.侧脑室副三角区穿刺治疗脑积水[J].中华神经创伤外科电子杂志,2016,2:86.
[5]张云鹤,吕淑娟.脑积水脑室-腹腔分流术后常见并发症及防治对策[J].中国临床新医学,2014,7:233.
[6]邱明兴,彭玉平,李煜,等.脑室端不同置管部位对脑室-腹腔分流术的影响[J].广东医学,2014,35:3191.
[7]刘洪涛,王琼,朱龙柏.小儿脑积水脑室-腹腔分流术后并发症研究[J].现代仪器与医疗,2016,22:38.
[8]Phan S,Liao J,Jia F,et al.Laparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus:A systematic review and meta-analysis[J].Clin Neurol Neurosurg,2016,140:26.
[9]Kandasamy J,Dwan K,Hartley JC,et al.Antibiotic-impregnated ventricuioperitoneal shunts-a multi-centre British paediatric neurosurgery group(BPNG)study using historical controls[J].Childs Nerv Syst,2011,27:575.
[10]Preuss M,Kutscher A,Wachowiak R,et al.Adult long-term outcome of patients after congenital hydrocephalus shunt therapy[J].Childs Nervous System,2015,31:49.
[11]徐规化.脑积水分流术后常见并发症及防治措施分析[J].河南外科学杂志,2013,19:97.
[12]Kulkarni AV,Riva-Cambrin J,Butler J,et al.Outcomes of CSFshunting in children:comparison of Hydrocephalus Clinical Research Network cohort with historical controls[J].J Neurosurg Pediatr,2013,12:334.
[2]Parker SL,Mcgirt MJ,Murphy JA,et al.Comparative effectiveness of antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus:analysis of 12,589 consecutive cases from 287 US hospital systems[J].J Neurosurg,2015,122:443.
[3]杨坤,刘宏毅,邹元杰,等.侧脑室-腹腔分流术治疗正常压力脑积水[J].临床神经外科杂志,2012,9:101.
[4]徐岩,曾光,孙飞.侧脑室副三角区穿刺治疗脑积水[J].中华神经创伤外科电子杂志,2016,2:86.
[5]张云鹤,吕淑娟.脑积水脑室-腹腔分流术后常见并发症及防治对策[J].中国临床新医学,2014,7:233.
[6]邱明兴,彭玉平,李煜,等.脑室端不同置管部位对脑室-腹腔分流术的影响[J].广东医学,2014,35:3191.
[7]刘洪涛,王琼,朱龙柏.小儿脑积水脑室-腹腔分流术后并发症研究[J].现代仪器与医疗,2016,22:38.
[8]Phan S,Liao J,Jia F,et al.Laparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus:A systematic review and meta-analysis[J].Clin Neurol Neurosurg,2016,140:26.
[9]Kandasamy J,Dwan K,Hartley JC,et al.Antibiotic-impregnated ventricuioperitoneal shunts-a multi-centre British paediatric neurosurgery group(BPNG)study using historical controls[J].Childs Nerv Syst,2011,27:575.
[10]Preuss M,Kutscher A,Wachowiak R,et al.Adult long-term outcome of patients after congenital hydrocephalus shunt therapy[J].Childs Nervous System,2015,31:49.
[11]徐规化.脑积水分流术后常见并发症及防治措施分析[J].河南外科学杂志,2013,19:97.
[12]Kulkarni AV,Riva-Cambrin J,Butler J,et al.Outcomes of CSFshunting in children:comparison of Hydrocephalus Clinical Research Network cohort with historical controls[J].J Neurosurg Pediatr,2013,12:334.