脑室-腹腔分流术治疗特发性正常压力脑积水的长期疗效观察  

Long-term efficacy of ventriculoperitoneal shunt in patient with idiopathic normal pressure hydrocephalus

作　　者：朱周乐 蔡成伟 郑喆[1] 蒋鸿杰 傅伟明[1] 俞群[1] 朱君明[1] Zhu Zhoule;Cai Chengwei;Zheng Zhe;Jiang Hongfie;Fu Weiming;Yu Qun;Zhu Junming(Department of Functional Neurosurgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属第二医院功能神经外科,杭州310000

出　　处：《中华神经外科杂志》2019年第2期140-143,共4页Chinese Journal of Neurosurgery

摘　　要：目的 观察脑室-腹腔(V-P)分流术治疗特发性正常压力脑积水(iNPH)的长期有效性及安全性。 方法 回顾性分析浙江大学医学院附属第二医院功能神经外科2014年4月至2016年4月收治的27例确诊为iNPH患者的临床资料。所有患者均采用V-P分流术治疗,术后根据随访问卷、Krauss量表评分(Krauss提高指数≥0.5分为效果明显)及改良Rankin量表评分(mRS)评估临床疗效。 结果 术后27例患者首次随访2~22个月,中位数为9.6个月,步态、认知或控尿任意一项改善者22例(81.5%),Krauss提高指数≥0.5分者17例(63.0%);末次随访失访2例,25例患者随访26~46个月,平均(36.0±8.3)个月,步态、认知或控尿任意一项改善者17例(68.0%),Krauss提高指数≥0.5分者15例(60.0%)。术后首次随访、末次随访的mRS中位数分别为1(0~4)分、1(0~5)分,差异无统计学意义(P=0.486);与术前的2(1~5)分比较,差异均有统计学意义(均P<0.05)。术后首次随访、末次随访的Krauss提高指数中位数分别为0.7(0~1)分及0.5(0~1)分,差异无统计学意义(P=0.301)。术后6例(22.2%,6/27)发生并发症,其中慢性硬膜下血肿1例、头痛1例、分流管堵塞1例、癫痫1例、腹部切口疼痛2例。 结论 V-P分流术治疗iNPH安全,术后长期疗效与近期疗效近似。Objective To investigate the long-term efficacy and safety of ventriculoperitoneal (VP) shunt in the treatment of idiopathic normal pressure hydrocephalus (iNPH).Methods The data of 27 patients diagnosed with iNPH admitted to Department of Functional Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of medicine from April 2014 to April 2016 were retrospectively analyzed. All those patients underwent VP shunt surgery, postoperative follow-up according to the questionnaire, Krauss rating scale (Krauss improved index ≥0.5 was considered as significant) and modified Rankin Scale (mRS) for clinical curative effect was analyzed.Results A total of 27 patients were followed up from 2 to 22 months(median: 9.6 months) after operation. Twenty-two (81.5%) patients showed improvement in gait, cognition or urine control, while 17 (63.0%) showed improvement in Krauss index ≥0.5. Two patients were lost to follow-up and 25 were followed up for 26 to 46 months, with an average of 36.0±8.3 months. Gait, cognition or urine control was improved in 17 (68.0%) cases and Krauss improvement index ≥0.5 accounted for 15(60.0%)cases. The mRS scores at the first and last postoperative follow-up were 1(0-4) and 1(0-5) respectively with no statistically significant difference (P=0.486). Compared with preoperative mRS score 2(1-5), the difference were statistically significant (both P<0.05). Krauss improvement index at the first and last postoperative follow-up were 0.7(0-1) and 0.5(0-1) respectively, and the difference was not statistically significant (P=0.301). Postoperative complications occurred in 6 (22.2%, 6/27) cases, including chronic subdural hematoma (1 case), headache (1 case), shunt blockage (1 case), epilepsy (1 case) and abdominal incision pain (2 cases).Conclusion VP shunt for patients with iNPH is safe and the long-term postoperative efficacy seems similar to short-term efficacy.

关 键 词：脑积水 正常压力 治疗结果 特发性 脑室腹膜分流术 长期 

分 类 号：R651.1[医药卫生—外科学]