早期一期手术治疗术后颅骨缺损并脑积水  

Early one-stage ventriculo-peritoneal shunt and cranioplasty for patients with postoperativeskull deficit and hydrocephalus

作　　者：王超[1] 韩国强[1] 王俊[1] 熊云彪[1] 高方友[1] 刘窗溪[1] 

机构地区：[1]贵州省人民医院神经外科,贵阳550002

出　　处：《中华神经医学杂志》2013年第1期79-81,共3页Chinese Journal of Neuromedicine

基　　金：贵阳市科技计划项目（[2010]筑科农合同字第1-社-34号）

摘　　要：目的 探讨一期行脑室一腹腔分流术＋颅骨修补术对大骨瓣减压术后颅骨缺损、脑积水及脑组织颅骨缺损疝的治疗效果。方法选择贵州省人民医院神经外科自2009年6月至2010年12月收治的38例大骨瓣减压术后出现颅骨缺损、脑积水及脑组织颅骨缺损疝的患者．于术后2个月内一期行脑室一腹腔分流术＋颅骨修补治疗。观察术后及6-24个月后随访结果。结果术后10d复查头颅CT示脑积水消失31例，明显缓解7例；38例患者中线结构均居中，缺损区钛网修补满意，外观良好。随访6-24月，平均13月，复查头颅CT脑积水消失30例，明显好转6例，脑积水复发2例．经再次行脑室腹腔一分流术后脑积水消失。结论早期一期行脑室一腹腔分流术＋颅骨修补术治疗去大骨瓣减压术后脑积水、颅骨缺损及脑组织缺损疝可取得良好效果，不增加手术风险及并发症发生率。Objective To investigate the therapic efficiency of early one-stage ventriculo-peritoneal shunt and cranioplasty on patients with skull deficit, hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression. Methods Thirty-eight patients with skull deficit, hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression, admitted to our hospital from June 2009 to December 2010, were chosen in our study; early （within two months of onset） one-stage ventriculo-peritoneal shunt and cranioplasty were performed on these patients; follow up was performed for 6-24 months. Results Postoperative CT scan 10 days after the surgery showed that hydrocephlus disappeared in 31 patients and significantly alleviated in 7; the midline located on the middle of the brain, and the titanium structure in the skull deficit was good. The follow-up of 6-24 months （mean 13 months） indicated that hydrocephlus disappeared in 30 patients, significantly alleviated in 6, and recurred in 2 patients under CT scan; recurred hydrocephalus disappeared after a new re-operation of ventriculo-peritoneal shunt. Conslusion The early one-stage ventriculo-peritoneal shunt and cranioplasty could achieve favorable outcome for patients with skull deficit, hydrocephalus and hernia in the cerebral tissue of deficited skull after large flap decompression.

关 键 词：大骨瓣减压 脑积水 颅骨缺损 脑室一腹腔分流术 颅骨修补术 

分 类 号：R651.15[医药卫生—外科学]