大骨瓣减压术后伴脑积水早期行改良脑室腹腔分流加颅骨修补术45例  

Early management of hydrocephalus secondary to large decompressive craniectomy by modified cranioplasty and ventriculoperitoneal shunt： a report of 45 cases

作　　者：胡伟鹏[1] 高宏志[1] 黄天造[1] 陈祥荣[1] 李亚松[1] 

机构地区：[1]福建医科大学附属第二医院神经外科,泉州362000

出　　处：《中华创伤杂志》2012年第4期324-327,共4页Chinese Journal of Trauma

摘　　要：目的探讨早期同时行改良脑室腹腔分流术及颅骨修补术治疗重型颅脑损伤大骨瓣减压术后伴脑积水的作用。方法回顾性分析2006年1月-2010年12月早期同时行改良脑室腹腔分流术及颅骨修补术的重型颅脑损伤大骨瓣减压术后伴脑积水患者45例，对其临床资料、并发症及预后进行总结。结果本组患者手术时间在伤后38-80d，术后并发分流管腹腔端阻塞2例，颅内感染1例；术后1个月症状明显改善36例（80％）；脑室不同程度缩小34例（76％）。出院时GOS评定：良好8例，中残19例，重残13例，长期昏迷5例，其中恢复较好（良好／中残）27例（60％），较术前有明显提高（X^2=23．47，P〈0．01）。结论早期、同时行改良脑室腹腔分流术及颅骨修补术治疗重型颅脑损伤大骨瓣减压术后伴脑积水是一种有效、安全的治疗方法。Objective To explore the role of improved cranioplasty plus ventriculoperitoneal shunt in early treatment of hydrocephalus secondary to decompressive craniectomy for patients with severe craniocerebral injury. Methods A retrospective study was performed on 45 patients complicated by hydrocephalus after deeompressive eraniectomy for severe craniocerebral injury treated with early stage im- proved eranioplasty plus ventriculoperitoneal shunt from January 2006 to December 2010. Then, the clini- cal data, complications and outcomes were summarized. Results All operations were carried out 38-80 days after injury. The postoperative complications were distal obstruction of ventriculoperitoneal shunt in two patients and intraeranial＇infection in one. The clinical symptoms were obviously improved in 36 pa- tients （80%） and the cerebral ventricle was diminished in 34 （76%） one month postoperatively. The Glasgow Outcome Scale （GOS） at discharge was good in eight patients, moderate disability in 19, severe disability in 13 and prolonged coma in five, where better recovery （good recovery and moderate disability） in 27 patients （ 60% ） showed significant improvement compared with Preoperation （ X2 = 23.47, P 〈 0.01 ）. Conclusion Early cranioplasty plus ventrieuloperitoneal shunt is an effective and safe method for treatment of the complicated hydrocephalus after deeompressive eraniectomy for severe craniocerebral

关 键 词：脑损伤 脑积水 脑室腹膜分流术 颅骨切除减压术 

分 类 号：R651.15[医药卫生—外科学]