53例脑室-心房分流术治疗脑室-腹腔分流术失败脑积水疗效分析  

Clinical analysis of ventriculoatrial shunts for hydrocephalus after failed ventriculoperitoneal shunt in 53 patients

作　　者：甘武 周东 詹升全 郭文龙 王鹏 李炎稳 Gan Wu;Zhou Dong;Zhan Shengquan;Guo Wenlong;Wang Peng;Li Yanwen(Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China)

机构地区：[1]广东省人民医院(广东省医学科学院)神经外科

出　　处：《中国微侵袭神经外科杂志》2019年第9期405-408,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨脑室-心房分流术(VAS)治疗脑室-腹腔分流术(VPS)失败脑积水的手术效果和危险因素分析。方法回顾性分析经VPS治疗失败而改行VAS的53例脑积水病人的临床资料,统计分析导致VAS术后失败的相关危险因素。结果随访3~111个月,VAS失败15例(28.3%),其中感染拔管2例,拔管改行VPS 4例,因堵管脑积水加重放弃治疗而死亡2例,因再次术后颅内感染死亡1例,余6例经手术调整后VAS有效。统计分析显示:手术时期和年龄是导致VAS术后失败的独立危险因素(P<0.05),VPS次数增加有降低VAS成功率的趋势。结论 VAS是治疗VPS失败脑积水的有效手段,年龄是VAS术后失败的独立危险因素,手术技术的优化和经验积累有助于提高成功率,成年人(>18岁)、VPS 2次以内的脑积水病人行VAS效果好。Objective To explore the surgical effect and risk factors of ventriculoatrial shunt(VAS) for the treatment of hydrocephalus after failed ventriculoperitoneal shunt(VPS). Methods Clinical data of 53 patients with hydrocephalus undergoing VAS after failed VPS were analyzed retrospectively, and the risk factors leading to VAS failure were analyzed statistically. Results During a follow-up period of 3 to 111 months, VAS failed in 15 patients(18.3%), including 2 patients whose shunt tubes were extubated due to intracranial infection, 4 patients who underwent VPS after tube extubation, 2 patients who died of hydrocephalus aggravation but abandoned treatment, 1 who died of intracranial infection after reoperation, and 6 who obtained efficacy VAS were effective after surgical adjustment. Statistical analysis showed that the operative period and age were independent risk factors for the failure of VAS,and the increase of VPS frequency would reduce the success rate of VAS. Conclusions VAS is an effective method for hydrocephalus after failed VPS. Age is an independent risk factor for VAS failure. Optimizing surgical techniques and enriching experience are helpful to improve the success rate. The effect of VAS is better in adults with VPS less than 2 times.

关 键 词：脑积水 脑室-心房分流术 脑室-腹膜分流术 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R651.1[医药卫生—临床医学]