开颅手术后轴外脑脊液蓄积的治疗体会  

Experience of treatment for accumulation of extra-axil cerebrospinal fluid after skull surgery

作　　者：赵杰[1,2] 刘景平[1,2] 张治平[1,2] 李建[1,2] 肖格磊[1,2] 廖新斌[1,2] 金晨[1,2] 

机构地区：[1]中南大学湘雅医院小儿神经外科 [2]中南大学湘雅医院脑积水诊疗中心,长沙410078

出　　处：《中南大学学报（医学版）》2015年第4期446-452,共7页Journal of Central South University ：Medical Science

摘　　要：目的:回顾性调查轴外脑脊液蓄积在开颅手术后的发生情况及治疗经过,并探讨其病理生理学机制与治疗方法。方法:选取46例经纵裂胼胝体入路的开颅手术治疗患者,对其治疗过程进行回顾性分析。结果:术后6 h内,CT复查该46例手术患者均出现轴外脑脊液蓄积。经观察与治疗后,5例发展为症状性轴外脑脊液蓄积,并进行了手术治疗。1例院外死亡,1例行硬膜下-腹腔分流,3例先行硬膜下-腹腔分流后改为脑室-腹腔分流。结论:开颅手术后经头部CT发现可疑轴外脑脊液蓄积者,应注意跟踪观察及时发现症状性轴外脑脊液蓄积。脑室-腹腔分流术与硬膜下-腹腔分流术是有效的治疗措施。Objective: To explore the treatment and pathophysiology of extra-axil cerebrospinal fluid accumulation af ter skull surgery.Methods: Th e treatment of 46 cases of pineal regional tumor was retrospectively studied.Results: The CT showed that all patients had postoperative extra-axil cerebrospinal fluid accumulation in 6 hours after operation. 5 cases displayed symptomatic accumulation of extra-axil cerebrospinal f luid. 1 died 30 days af ter discharge, 4 performed S-P shunt and 3 of them switched to V-P shunt af ter S-P shunt failed.Conclusion: Much more attention should be paid to postoperative accumulation of extra-axil cerebrospinal fl uid. Both V-P and S-P are the eff ective strategies of therapy.

关 键 词：开颅手术 并发症 术后轴外脑脊液蓄积 硬膜下-腹腔分流术 脑室-腹腔分流术 脑外积水 

分 类 号：R651.1[医药卫生—外科学]