脑室-腹腔分流术联合同期颅骨修补术治疗脑创伤合并脑积水的临床疗效  

Effect of Ventriculoperitoneal Shunt Combined with Simultaneous Cranioplasty in Treatment of Traumatic Brain Injury with Hydrocephalus

作　　者：高玉华 赵有发 魏民 何洪泉 夏鹏飞 张远明 程刚[2] GAO Yuhua;ZHAO Youfa;WEI Min;HE Hongquan;XIA Pengfei;ZHANG Yuanming;CHENG Gang(Department of Neurosurgery,Gaochun People′s Hospital,Nanjing 211300,China;Department of Neurosurgery,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京市高淳人民医院神经外科,南京211300 [2]江苏省人民医院神经外科,南京210029

出　　处：《医学综述》2020年第9期1869-1872,F0003,共5页Medical Recapitulate

摘　　要：目的探讨脑室-腹腔(VP)分流术联合同期颅骨修补术治疗脑创伤合并脑积水的临床疗效。方法选择2013年8月至2017年12月南京市高淳区人民医院和江苏省人民医院神经外科收治的颅脑损伤合并脑积水患者60例,按照治疗方法不同分为对照组和观察组,各30例。对照组患者采取VP分流术和择期颅骨修补术治疗,观察组采取VP分流术和同期颅骨修补术治疗。比较两组患者的术后疗效,术前和术后6个月侧脑室大小变化、格拉斯哥昏迷评分(GCS)、日常生活活动能力评分(ADL)、神经功能缺损积分,术前和术后3 d血中皮质醇(GC)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平变化,以及术后并发症发生率。结果观察组患者术后良好率高于对照组[76. 7%(23/30)比50. 0%(15/30)](P <0. 05);两组患者术后侧脑室小于术前,且观察组小于对照组[(0.26±0.11) cm比(0.31±0.14) cm](P <0.05);术后观察组GCS评分、ADL评分高于对照组[(13. 23±0. 80)分比(10.68±1.21)分,(77.53±1.62)分比(65.05±1.64)分](P <0. 05),观察组神经功能缺损积分低于对照组[(10. 62±0. 74)分比(13. 70±0. 52)分];两组患者术后3 d血清GC、IL-6和TNF-α水平较术前上升,且观察组低于对照组[(66. 68±4. 76)μg/L比(78. 68±6. 55)μg/L,(22. 28±1. 16) ng/L比(27. 34±1. 66) ng/L,(3. 06±0. 45) ng/L比(4.73±0.95) ng/L](P <0.05);术后观察组并发症的发生率低于对照组[6. 7%(2/30)比22. 7%(8/30)](P <0. 05)。结论 VP分流术联合同期颅骨修补术对脑创伤合并脑积水的临床治疗效果佳,可改善神经功能、减少应激反应。Objective To investigate the effect of ventriculoperitoneal shunt( VP) combined with simultaneous cranioplasty on traumatic brain injury complicated with hydrocephalus. Methods From Aug. 2013 to Dec. 2017,60 inpatients with brain trauma and hydrocephalus from the Department of Neurosurgery,Gaochun People’s Hospital of Nanjing and Jiangsu Province Hospital were included in the study. According to the treatment methods,they were divided into a control group and an observation group,30 cases each. The control group was treated with VP shunt and selective cranioplasty,while the observation group was treated with VP shunt and simultaneous cranioplasty. The postoperative efficacy,changes of the size of the lateral ventricle,activities of daily living( ADL),Glasgow coma score( GCS),neurological impairment score,the levels of serum glucocorticoid( GC),interleukin-6( IL-6) and tumor necrosis factor-α( TNF-α) on the third day after operation,incidence of complications the two groups were compared. Results The postoperative good rate of the observation group was higher than that of the control group[76. 7%( 23/30) vs 50. 0%( 15/30) ]( P < 0. 05);the size of lateral ventricles in the two groups after operation was smaller than that before operation,and that in the observation group was better than that in the control group[( 0. 26 ± 0. 11) cm vs( 0. 31 ± 0. 14) cm]( P < 0. 05);the postoperative GCS score,ADL score of the observation group were better than that of the control group( 13. 23 ± 0. 80 vs 10. 68 ± 1. 21,77. 53 ± 1. 62 vs 65. 05 ± 1. 64)( P < 0. 05),the score of neurological impairment in the observation group was lower than that in the control group( 10. 62 ± 0. 74 vs 13. 70 ±0. 52);the contents of serum GC,IL-6 and TNF-α on the third day after operation in the two groups were significantly higher than that before operation,and that in the observation group was lower than that in the observation group[( 66. 68 ±4. 76) μg/L vs( 78. 68 ± 6. 55) μg/L,( 22. 28 ± 1. 16) ng/L vs( 27. 34 ± 1. 66) ng/L,

关 键 词：脑创伤 脑积水 脑室-腹腔分流术 颅骨修补术 

分 类 号：R742.7[医药卫生—神经病学与精神病学]