脑室腹腔分流管堵塞相关危险因素统计分析
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摘要
目的通过统计分析,探讨脑室腹腔分流术(ventriculoperitoneal shunt, V-Ps)术后分流管堵塞的相关危险因素。方法回顾性分析78例行V-Ps的病人的临床资料,记录病人年龄、性别、腹腔炎症病史、术前脑脊液蛋白及细胞数、手术方式、术中有无反复穿刺脑室等(不少于3次),Logistic回归分析V-Ps术后分流管堵塞的独立危险因素。结果随访1年,发生堵塞23例(29.5%)。Logistic回归分析表明：腹腔炎症病史、术前脑脊液蛋白及细胞数、手术方式、术中有无反复穿刺脑室是V-Ps术后分流管堵塞的独立危险预测因素；而性别、年龄与V-Ps术后分流管堵塞无明显关系。结论腹腔炎症病史、术前脑脊液蛋白及细胞数、手术方式、术中有无反复穿刺脑室是V-Ps术后分流管堵塞的高危因素。
objective:To explore the related risk factors of shunt pipe plugging after ventriculoperitoneal shunt(V-Ps) Through the statistical analysis.Methods Clinical data of78patients had accepted V-Ps were analyzed retrospectively, The factors such as age, sex, celiac inflammation history, preoperative cerebrospinal fluid protein and cell number, operation mode, whether puncture ventricle repeatedly in surgery (no less than three times)were recorded. The independent risk factors of shunt pipe plugging after V-Ps were evaluated by Logistic regression analysis. Results During a follow-up of1year, happen jam23cases (29.5%).Logistic regression analysis showed that:celiac inflammation history, preoperative cerebrospinal fluid protein and cell number, operation mode, whether puncture ventricle repeatedly in surgery were the independent risk prediction factors of shunt pipe plugging after V-Ps;There was no significant relationship between shunt pipe plugging after V-Ps and factors as sex and age. Conclusion celiac inflammation history, preoperative cerebrospinal fluid protein and cell number,operation mode,whether puncture ventricle repeatedly in surgery are the high-risk factors of shunt pipe plugging after V-Ps.
objective:To explore the related risk factors of shunt pipe plugging after ventriculoperitoneal shunt(V-Ps) Through the statistical analysis.Methods Clinical data of78patients had accepted V-Ps were analyzed retrospectively, The factors such as age, sex, celiac inflammation history, preoperative cerebrospinal fluid protein and cell number, operation mode, whether puncture ventricle repeatedly in surgery (no less than three times)were recorded. The independent risk factors of shunt pipe plugging after V-Ps were evaluated by Logistic regression analysis. Results During a follow-up of1year, happen jam23cases (29.5%).Logistic regression analysis showed that:celiac inflammation history, preoperative cerebrospinal fluid protein and cell number, operation mode, whether puncture ventricle repeatedly in surgery were the independent risk prediction factors of shunt pipe plugging after V-Ps;There was no significant relationship between shunt pipe plugging after V-Ps and factors as sex and age. Conclusion celiac inflammation history, preoperative cerebrospinal fluid protein and cell number,operation mode,whether puncture ventricle repeatedly in surgery are the high-risk factors of shunt pipe plugging after V-Ps.
引文
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[2]王忠诚.王忠诚神经外科学[M].武汉：湖北科学技术出版社,2005：1081—1083.
[3]聂柳,赵刚,曹德文,等.脑积水患者行脑室—腹腔分流术后并发症分析[J].吉林医学,2009,30(4)：355.
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[6]余定庸,唐文国,罗红国.等.脑窀内出血外引流治疗初步探讨.中国煤炭工业医学杂志,2003.6：947.
[7]黄绳跃,王开字,黄克涛,脑室—腹腔分流术治疗脑积水.中华神经外科杂志.1999,15：385.3.
[8]夏祥新,王刚,谢炎秋.脑室-腹腔分流管堵塞5例原因分析[J].中国实用神经疾病杂志,2007,10(6)：86～87.
[9]马颖,陈复仁,程远.成人脑室—腹腔分流术后并发症分析：附16例报告[J].重庆医科大学学报,1999,24(4)：421-422.
[10]彭琳。王玉民,牛光明.正常压力脑积水低压和中压分流比较[刀.河南实用神经疾病杂志,1999,3(2)1122.
[11]尹先印,冒冬梅.侧脑室—腹腔分流术疗效与并发症[刀.中国误诊学杂志,2002,2(8)11221.
[12]陈真,李广庆,华扬,等.早期发现脑室—腹腔分流管阻塞的三种检测方法[J].中 国脑血管病杂志,2004,1(9)：4057.
[13]章翔.临床神经外科学[M].北京：人民军医出版社,2006：51—139.
[14]高建忠,张吕荣,李军,等.改良分流技术治疗脑积水25例[J].中国临床神经外科杂志,2004,96(2)：142—3.
[15]刘志雄,张明宇.侧脑室—腹腔分流术治疗交通性脑积水的临床分析[J].中国医师进修杂志,2006,29(12)：146.
[16]Kulkami AV, Rabin D, Lamberti paseulli M, et al.Repeat cerebrospinal fluid shunt infection inchildren[J]. J PediatrNeurosurg,2001,35(2):66-71.
[17]姚长义,梁传声,公茂青.成人交通性脑积水脑室-腹腔分流失败原因分析[J].中华神经外科杂志,1999,15(2)：119～121.
[18]王启弘.刘恩重,韩占强,等.脑室-腹腔分流术治疗脑积水.中华神经外科杂志,2001,17：305.
[19]常文海,姬馨彤,张俊杰,等.脑积水分流术分流管近端位置与疗效.中华神经外科杂志,2004,20：482.
[20]华春华,王岳华,谢思忠,等.腹腔镜辅助下治疗脑积水.中华神经医学杂志,2005,04：389.
[21]Kesde J, Drake J, Milner R, et al.Long termfollow up data from the Shunt Design Trial [J].PedNeurosurg,2000,33(5):230-6.
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[2]Robert GGrossman(美),Cristopher MLoftus(美),王任直译.神经外科学[M].北京：人民卫生出版社,2002：76-86.
[3]. S.Greenberg(德),赵继宗译.神经外科手册[M].山东：山东科学技术出版社,2004：231-265.
[4].Lane JI,Luetmer PH,Atkinson JL.Corpus callosal signal changes in patientswith obstructive hydrocephalus after vertriculloperitoneal shunting. AJNR,2001,22(1):158-162
[5]Shoesmith CL,Buist R,Del Bigio MR.Magnetic imaging study of ctracellularfluidtracer movement in brains of immature rates with hydrocephalus.Neural Rres 2000,22(1):111-6
[6]Silva MC,Michowwicz S,Drake JM,et al.reduced local cerebreal blood flows in per ventricular White matter in experimental neonatal hydrocephalus-restoration with CSF shunting J Cereb Blood Flow Metab 1995; 15(6):1057-65
[7]刘建雄,刘海霞,李东燕.急性脑卒中患者血清及脑脊液中神经元特异性烯醇化酶水平与神经功能缺失的关系[J]中国临床康复,2004,8(34)；7716-7
[8]DING Y,MCALLISER jp 2nd,yao b,et al.neuron tolerance during hydrocephalus. Neuroscience 2011:106(4):659-67
[9]del bigio mr,bruni je.silicone oil-induced hydrocephalus in the rabbit.childs rerv syst 1991:7(2):79-84
[10]Mangano FT, cMAllister JP 2nd, Jones HC, et al.The microglial response to propressivehydrocephalusin a modl of inherited aqueductal stenosis. Neurol Res1998:20(8):697-704
[11]Bateman GA. Vascular compliance hydrocephalus AJNR Am J Neuroradiol 2000:21(9):1574-81
[12]Hayashi M, Kurata k, Suzuki K,et al. Megalencephaly, hydrocephalus and cortical dysphasia in servere dwarfism mimicking leprechaunism. acta Neuroradiol (Berl)1998:95(4):431-6
[13]Perez Figares JM, Jimencz AJ, Perez-Martin M,et al. Spontaneous congenital hydrocephalus in the mutant mouse hyh, Changes in the wentricular system and the sub commissural organ. J Neuropathol Exp Neurol 1998:57(2):188-202
[14]Yamada Y, Watanabe Y,Zhang J,at al. Changes in cortical and cerebella bcl-2 mRNA levels in the developing hhydrocephalic rat(LEW-HYR) as measured by a real time quantified RT-PCR Neurosience 2002:114(1):165-171
[15]Del Bigio MR, Wang X, Wilson MJ. Sodium channel-blocking agents are not of benefit to ratiswith kaolin-induced hydrocephalus.Nerosurgery 2002:51 (2):460-466
[16]Nojima Y, Enzan H,Hayashi Y,et al. Neuroepithelial and changes in HTX rat with congenital hydrocephalus:an ultra structural and immunohisto-chemical study.Pathol lnt 1998:48(2):115-125
[17]Klinge P,Muhlendyck A, Lee S,et al.Temporal and regional profile of neuronal an gliacellular injury after induction of kaolin hudrocephalus.Acta Nerochir Suppl 2002:81:275-277
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[19]suzan Sacar. Huseyin Turgut, semra Toprak, et al. A retro spective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period[J]. BMc Infectious Diseases,2006.6(43); 1-5
[20]Ullrich M, Johannes L, Ferass AZ. Clinical experience in the treatment of idiopathic normal—pressure hydrocephalus using the programmable gravity—assisted Valve(ProGAVAescu—lap)[J]. Neurosurgery, 2007,17(1):52-55.
[21]Kulkami AV, Rabin D, Lamberti—pasculli M, et al. Repeatcerebro—spinal fluid shunt infection in children[J]. Pediatr Neuro—surg,2001, 35(2):66-71.
[22]Sciubba DM, Stuart RM, MeGirt MJ, et al. Effect of antibiotic—impregnated shunt catheters in decreasing the incidence of shunt infectionin the treatment of hydrocephalus[J]. Neuro Surg,2005,103, (2):131-136.
[23]马颖,陈复仁,程远.成人脑室一腹腔分流术后并发症分析：附16例报告[J].重庆医科大学学报,1999,24(4)：421-422.
[24]姚长义,梁传声,公茂青.成人交通性脑积水脑室-腹腔分流失败原因分析[J].中华神经外科杂志,1999,15(2)：119～121.
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[3]聂柳,赵刚,曹德文,等.脑积水患者行脑室—腹腔分流术后并发症分析[J].吉林医学,2009,30(4)：355.
[4]曾世发,彭模芬,刘华庆,等.检测脑室-腹腔分流管堵塞的三种方法[J].中华神经外科疾病研究杂志(Chin JNeurosurgDisRes),2006,5(3):271-272
[5]常文海,馨彤,张俊杰.等.脑积水分流术分流管近端位置与疗效.中华神经外科杂志,2004,20：482.
[6]余定庸,唐文国,罗红国.等.脑窀内出血外引流治疗初步探讨.中国煤炭工业医学杂志,2003.6：947.
[7]黄绳跃,王开字,黄克涛,脑室—腹腔分流术治疗脑积水.中华神经外科杂志.1999,15：385.3.
[8]夏祥新,王刚,谢炎秋.脑室-腹腔分流管堵塞5例原因分析[J].中国实用神经疾病杂志,2007,10(6)：86～87.
[9]马颖,陈复仁,程远.成人脑室—腹腔分流术后并发症分析：附16例报告[J].重庆医科大学学报,1999,24(4)：421-422.
[10]彭琳。王玉民,牛光明.正常压力脑积水低压和中压分流比较[刀.河南实用神经疾病杂志,1999,3(2)1122.
[11]尹先印,冒冬梅.侧脑室—腹腔分流术疗效与并发症[刀.中国误诊学杂志,2002,2(8)11221.
[12]陈真,李广庆,华扬,等.早期发现脑室—腹腔分流管阻塞的三种检测方法[J].中 国脑血管病杂志,2004,1(9)：4057.
[13]章翔.临床神经外科学[M].北京：人民军医出版社,2006：51—139.
[14]高建忠,张吕荣,李军,等.改良分流技术治疗脑积水25例[J].中国临床神经外科杂志,2004,96(2)：142—3.
[15]刘志雄,张明宇.侧脑室—腹腔分流术治疗交通性脑积水的临床分析[J].中国医师进修杂志,2006,29(12)：146.
[16]Kulkami AV, Rabin D, Lamberti paseulli M, et al.Repeat cerebrospinal fluid shunt infection inchildren[J]. J PediatrNeurosurg,2001,35(2):66-71.
[17]姚长义,梁传声,公茂青.成人交通性脑积水脑室-腹腔分流失败原因分析[J].中华神经外科杂志,1999,15(2)：119～121.
[18]王启弘.刘恩重,韩占强,等.脑室-腹腔分流术治疗脑积水.中华神经外科杂志,2001,17：305.
[19]常文海,姬馨彤,张俊杰,等.脑积水分流术分流管近端位置与疗效.中华神经外科杂志,2004,20：482.
[20]华春华,王岳华,谢思忠,等.腹腔镜辅助下治疗脑积水.中华神经医学杂志,2005,04：389.
[21]Kesde J, Drake J, Milner R, et al.Long termfollow up data from the Shunt Design Trial [J].PedNeurosurg,2000,33(5):230-6.
[1]王忠诚.王忠诚神经外科学[M].武汉：湖北科学技术出版社,1998：375-377.
[2]Robert GGrossman(美),Cristopher MLoftus(美),王任直译.神经外科学[M].北京：人民卫生出版社,2002：76-86.
[3]. S.Greenberg(德),赵继宗译.神经外科手册[M].山东：山东科学技术出版社,2004：231-265.
[4].Lane JI,Luetmer PH,Atkinson JL.Corpus callosal signal changes in patientswith obstructive hydrocephalus after vertriculloperitoneal shunting. AJNR,2001,22(1):158-162
[5]Shoesmith CL,Buist R,Del Bigio MR.Magnetic imaging study of ctracellularfluidtracer movement in brains of immature rates with hydrocephalus.Neural Rres 2000,22(1):111-6
[6]Silva MC,Michowwicz S,Drake JM,et al.reduced local cerebreal blood flows in per ventricular White matter in experimental neonatal hydrocephalus-restoration with CSF shunting J Cereb Blood Flow Metab 1995; 15(6):1057-65
[7]刘建雄,刘海霞,李东燕.急性脑卒中患者血清及脑脊液中神经元特异性烯醇化酶水平与神经功能缺失的关系[J]中国临床康复,2004,8(34)；7716-7
[8]DING Y,MCALLISER jp 2nd,yao b,et al.neuron tolerance during hydrocephalus. Neuroscience 2011:106(4):659-67
[9]del bigio mr,bruni je.silicone oil-induced hydrocephalus in the rabbit.childs rerv syst 1991:7(2):79-84
[10]Mangano FT, cMAllister JP 2nd, Jones HC, et al.The microglial response to propressivehydrocephalusin a modl of inherited aqueductal stenosis. Neurol Res1998:20(8):697-704
[11]Bateman GA. Vascular compliance hydrocephalus AJNR Am J Neuroradiol 2000:21(9):1574-81
[12]Hayashi M, Kurata k, Suzuki K,et al. Megalencephaly, hydrocephalus and cortical dysphasia in servere dwarfism mimicking leprechaunism. acta Neuroradiol (Berl)1998:95(4):431-6
[13]Perez Figares JM, Jimencz AJ, Perez-Martin M,et al. Spontaneous congenital hydrocephalus in the mutant mouse hyh, Changes in the wentricular system and the sub commissural organ. J Neuropathol Exp Neurol 1998:57(2):188-202
[14]Yamada Y, Watanabe Y,Zhang J,at al. Changes in cortical and cerebella bcl-2 mRNA levels in the developing hhydrocephalic rat(LEW-HYR) as measured by a real time quantified RT-PCR Neurosience 2002:114(1):165-171
[15]Del Bigio MR, Wang X, Wilson MJ. Sodium channel-blocking agents are not of benefit to ratiswith kaolin-induced hydrocephalus.Nerosurgery 2002:51 (2):460-466
[16]Nojima Y, Enzan H,Hayashi Y,et al. Neuroepithelial and changes in HTX rat with congenital hydrocephalus:an ultra structural and immunohisto-chemical study.Pathol lnt 1998:48(2):115-125
[17]Klinge P,Muhlendyck A, Lee S,et al.Temporal and regional profile of neuronal an gliacellular injury after induction of kaolin hudrocephalus.Acta Nerochir Suppl 2002:81:275-277
[18]曹丹庆,蔡祖龙.全身CT诊断学[M].北京：人民军医出版社,1996：206-219.
[19]suzan Sacar. Huseyin Turgut, semra Toprak, et al. A retro spective study of central nervous system shunt infections diagnosed in a university hospital during a 4-year period[J]. BMc Infectious Diseases,2006.6(43); 1-5
[20]Ullrich M, Johannes L, Ferass AZ. Clinical experience in the treatment of idiopathic normal—pressure hydrocephalus using the programmable gravity—assisted Valve(ProGAVAescu—lap)[J]. Neurosurgery, 2007,17(1):52-55.
[21]Kulkami AV, Rabin D, Lamberti—pasculli M, et al. Repeatcerebro—spinal fluid shunt infection in children[J]. Pediatr Neuro—surg,2001, 35(2):66-71.
[22]Sciubba DM, Stuart RM, MeGirt MJ, et al. Effect of antibiotic—impregnated shunt catheters in decreasing the incidence of shunt infectionin the treatment of hydrocephalus[J]. Neuro Surg,2005,103, (2):131-136.
[23]马颖,陈复仁,程远.成人脑室一腹腔分流术后并发症分析：附16例报告[J].重庆医科大学学报,1999,24(4)：421-422.
[24]姚长义,梁传声,公茂青.成人交通性脑积水脑室-腹腔分流失败原因分析[J].中华神经外科杂志,1999,15(2)：119～121.
[25]夏祥新,王刚,谢炎秋.脑室-腹腔分流管堵塞5例原因分析[J].中国实用神经疾病杂志,2007,10(6)：86～87.
[26]王忠诚.王忠诚神经外科学[M].武汉：湖北科学技术出版社,2005.3：1080～1081.
[27]山东医学院附属医院神经科.快速细孔钻颅器与其在临床的应用.医药学报(山东医学院学报前身)1974,2：87-93
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