脑室-腹腔分流术治疗结核性脑膜炎性脑积水10例  

Ventriculo-peritoneal shunt for tuberculous meningitis combined with hydrocephalus: 10 cases report

作　　者：黄玉宝[1] 陈子祥[1] 张俊全[2] 谢祎[3] 王健[1] 柳兴军[1] 刘慧权[1] 袁小勇[1] 

机构地区：[1]天津市海河医院神经外科,300350 [2]天津市海河医院病案科,300350 [3]天津市海河医院预防科,300350

出　　处：《中国微侵袭神经外科杂志》2017年第3期123-125,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：天津市卫生局科技基金(编号:09KZ38)

摘　　要：目的探讨脑室-腹腔分流术(VPS)治疗结核性脑膜炎性脑积水(TBMH)的疗效。方法回顾性分析10例TBMH病人的临床资料,在抗结核治疗的基础上行VPS,并统计分析手术前后Vellore分级、脑室-颅比率、颅内压及脑脊液参数检验指标。结果与术前相比,术后Vellore分级Ⅲ~Ⅳ级病人明显减少,而Ⅰ~Ⅱ级病人增多(P<0.01),病人Vassilouthis法脑室-颅比率减小(P<0.01),颅内压均恢复正常,脑脊液参数指标均有好转,其中恢复正常6例。术后遗留左眼外展功能障碍1例,出现腹泻1例。8例术后随访8个月,失访1例,因堵管二次修管1例,其余病人临床症状缓解,复查头颅CT脑室大小正常。结论 VPS是治疗TBMH的一种有效方法,可改善TBMH病人的预后。Objective To investigate the therapeutic effect of ventriculo-peritoneal shunt （ VPS ） for tuberculous meningitis with hydrocephalus （TBMH）. Methods Clinical data of 10 TBMH patients were analyzed retrospectively, and all the patients underwent VPS on the basis of anti-tuberculosis treatment. Vellore grade, ventricle-cranial ratio, intracranial pressure and laboratory indicators of cerebrospinal fluid preoperation and postoperation were analyzed statistically. Results Compared with preoperation, patients with Vellore gradesⅢtoⅣobviously decreased while those with gradesⅠtoⅡincreased postoperation （P〈0.01）. The ventricle-cranial ratio decreased （P〈0.01）, and intracranial pressure returned to normal after the operation in all the patients. The laboratory indicators of cerebrospinal fluid improved in all the patients, and returned to normal in 6 patients. The left eye had disturbance of abduction function in 1 patient and diarrhea occurred in 1 after the operation. Eight patients were followed up for 8 months, and one patient was lost to follow-up. One patient underwent secondary operation due to drainage tube plugging. The clinical symptoms relieved in other patients, and ventricular size returned to normal based on CT scan. Conclusions VPS is an effective method for the treatment of TBMH, and can improve the prognosis of TBMH patients.

关 键 词：脑积水 脑膜炎 结核性 中枢神经系统 脑室-腹腔分流术 

分 类 号：R651.1[医药卫生—外科学]