探讨重型颅脑创伤去骨瓣减压术后脑积水的治疗方案  

Discussion on the treatment programs of hydrocephalus after decompressive craniectomy of severe traumatic brain injury

作　　者：葛云飞[1] 胡群亮[1] 蒋显峰 高培龙[1] 张民[1] 令狐海瑞[1] 王伟[1] 薄寅 周星[1] 张赛[1] 

机构地区：[1]天津武警后勤学院附属医院脑科医院,武警部队创伤与神经疾病研究所,300162

出　　处：《中华神经创伤外科电子杂志》2015年第4期16-20,共5页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：武警后勤学院附属医院种子基金项目(FYM201547)

摘　　要：目的探讨治疗重型颅脑创伤去骨瓣减压术后合并创伤后脑积水(PTH)患者的不同手术方案。方法回顾性分析89例重型颅脑创伤患者行开颅去骨瓣减压后合并创伤后脑积水的临床资料。以手术方式不同分为:早期组即早期行脑室-腹腔分流术(VPS)+颅骨修补术17例;延期组即延期行脑室-腹腔分流术(VPS)+颅骨修补术22例;先行VPS再行颅骨修补术组31例(先VPS组),先行颅骨修补术再行VPS组19例(后VPS组)。结果早期组、延期组、先VPS组和后VPS组治疗有效率分别为88.2%、86.4%、90.3%、89.5%,四组之间差异无统计学意义(P>0.05);且各组并发症中分流堵管率并无差异(P>0.05);早期组头皮感染发生率明显高于先行VPS组(17.6%VS6.5%),先VPS组及后行VPS组术后硬膜下积液或血肿发生率(分别为3.2%和5.2%)均明显低于早期组及晚期组(分别为11.76%和9.09;P<0.05)。结论针对重型颅脑创伤去骨瓣减压术后引起的创伤后脑积水患者,早期、晚期及先VPS组、后VPS组治疗方案选择无差异,手术方案的选择益于以患者病情而行。Objective To investigating the different surgical plans for patients with hydrocephalus after decompressive craniectomy of severe traumatic brain injury. Methods The clinical data of 89 patients with severe traumatic brain injury underwent craniotomy to bone flap decompression combined with post- traumatic hydrocephalus after trauma were retrospectively analyzed. Four groups were difined according to the different operation mode ： group of early ventriculo-peritoneal shunt （VPS） ＋cranioplasty seventeen cases; group delay extension of ventriculo peritoneal shunt （VPS） ＋ skull neoplasty in twenty-two cases; first VPS for cranioplasty group thirty-one cases （VPS）, first skull repair surgery again VPS group nineteen cases （after VPS group）. Results Early group, group delay, first VPS group and after VPS group treatment efficiency was 88.2% , 86.4%, 90.3% and 89.5%,respectively. The differences between any two groups show no statistical significance （P〉0.05）;and the complications of the three groups in shunt tube plugging rate.

关 键 词：重型颅脑创伤 创伤后脑积水 颅骨修补术 硬膜下积液 手术方案 

分 类 号：R651.15[医药卫生—外科学]