去骨瓣减压术后脑积水的治疗策略及手术并发症的分析  

Analysis of the treatment strategies and surgical complications of hydrocephalus after decompressive craniectomy

作　　者：张建斌[1] 黄齐兵[2] 纪延伟[1] 张法学[1] 董保忠 

机构地区：[1]山东省交通医院神经外科,济南250031 [2]山东大学齐鲁医院急诊外科

出　　处：《中华神经外科杂志》2016年第10期1029-1033,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨去骨瓣减压术后脑积水治疗的合理手术时机与手术方式并统计其并发症特点.方法 回顾性分析2009年1月至2015年2月山东省交通医院神经外科和山东大学齐鲁医院急诊外科同期（21例）或分期（33例）行颅骨修补术和脑室-腹腔（V-P）分流术的54例患者的病例资料,分析并讨论2种术式的手术时机以及手术相关并发症.结果 手术并发症发生率为32％（17/54）,同期行颅骨修补术、V-P分流术组的并发症发生率高于分期手术组（57％比15％;P＜0.05）,其中同期手术组术后感染发生率明显高于分期手术组（P=0.02）.皮瓣膨隆患者术后并发症的发生率高于皮瓣凹陷者（40％比16％,P＜0.05）;两组中颅骨修补术与V-P分流术的先后顺序、颅骨缺损面积、脑积水的程度对并发症的影响差异均无统计学意义（均P＞0.05）.但有13例患者在先行颅骨修补术后因脑积水明显改善而未再行V-P分流术.结论 分期行颅骨修补术和V-P分流术因为其较低的并发症发生率可能对患者的治疗更有益,尤其是对于术前皮瓣膨隆明显的患者更应如此.因2种术式的先后顺序对术后并发症并无影响,且部分颅骨修补术后无需再行V-P分流术,故建议对无皮瓣膨隆的患者先行颅骨修补术.Objectives To investigate the reasonable operation time and operation approaches of the hydrocephalus treatment after decompressive craniectomy and to count its complication characteristics.Methods FromJanuary 2009 to February 2015,the clinical data of 54 patients treated with cranioplasty and ventricular peritoneal （V-P） shunt at the same time （n =21） or different time （n =33） at the Department of Neurosurgery,Shandong Jiaotong Hospital and the Emergency Surgery,Qilu Hospital of Shandong University were analyzed retrospectively.The operation time of both procedures and the operation related complications were analyzed and discussed.Results The surgical complication rate was 32% （17/54）.The occurrence rates of complications of cranioplasty and V-P shunt groups over the same period were higher than those of the staging operation group （57% vs.15%;P 〈 0.05）.The incidence of postoperative infection of the synchronous operation group was significantly higher than that of the staging operation group （P 〈 0.02）.The incidence of postoperative complication in patients with flap bulging was higher than that in patients with flap depression （40% vs.16%,P〈0.05）.There were no statistical significance in the effects of successively order,skull defect area,and degree of hydrocephalus on complications of the cranioplasty and V-P shunt between the 2 groups,however,13 patients did not treated with V-P shunt because of their hydrocephalus were improved significantly after the first cranioplasty.Conclusions Because of its lower incidence of complications,the staging cranioplasty and V-P shunt might be more beneficial to the treatment of patients,especially for those with obvious flap bulging.Because the order of 2 procedures did not have any effect on postoperative complications and no need to perform V-P shunt after partial cranioplasty,therefore,it was recommended that patients without flap bulging should conduct cranioplasty first.

关 键 词：减压术 外科 脑积水 神经外科手术 手术后并发症 

分 类 号：R651.1[医药卫生—外科学]