终板造瘘联合腰池引流对破裂动脉瘤术后脑积水的疗效分析  

The efficacy of lamina terminalis fenstration combined with lumbar cistern drainage for preventing hydrocephalus after operation of ruptured aneurysm

作　　者：黄志敏[1] 王敏[1] 罗安志 吴云[1] 张宗银[1] 黄光富[2] HUANG Zhi-min;WANG Min;LUO An-zhi;WU Yun;ZHANG Zong-yin;HUANG Guang-fu(Department of Neurosurgery,Meishan People's Hospital,Meishan 620010,China;Department of Neurosurgery,Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省眉山市人民医院神经外科,四川眉山620010 [2]四川省医学科学院.四川省人民医院神经外科,四川成都610072

出　　处：《实用医院临床杂志》2020年第4期63-65,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨终板造瘘联合腰池引流对破裂动脉瘤夹闭术后脑积水的疗效。方法2017年1月至2019年4月眉山市人民医院收治的前循环动脉瘤破裂蛛网膜下腔出血患者118例,其中54例(治疗组)予以开颅前腰池置管、术后引流,联合术中终板造瘘,64例(对照组)行单纯动脉瘤夹闭,比较两组术后脑积水发生率及行脑室腹腔分流的比率。结果118例患者23例(19.5%)发生急性脑积水(治疗组5例,对照组18例),治疗组2例、对照组7例发生分流依赖性脑积水;Hunt-Hess III、IV级患者中,急性脑积水的发生率分别为13.2%、36.4%,分流依赖性脑积水的发生率分别为7.9%、15.9%;合并脑室积血的患者中,分流依赖性脑积水的发生率分别为5.9%、15.8%。结论术中终板造瘘联合腰池引流可减少破裂动脉瘤夹闭术后急性脑积水发生。Objective To explore the efficacy of lamina terminalis fenestration combined with lumbar drainage for preventing hydrocephalus after clipping of ruptured aneurysm.Methods A total of 118 patients with ruptured anterior circulation aneurysms and subarachnoid hemorrhage from January 2017 to April 2019 were analyzed retrospectively.Of the patients,54(treatment group)were treated with preoperative lumbar cistern catheterization and postoperative drainage and combined with lamina terminalis fenestration,and another 64(control group)were treated with simple aneurysm clipping.The incidence of hydrocephalus and the ratio of ventriculoperitoneal shunt were compared between the two groups.Results Of the 118 patients,acute hydrocephalus occurred in 23 patients(19.5%),in whom 5 patients in the treatment group and 18 patients in the control group.Shunt dependent hydrocephalus occurred in 2 patients in the treatment group and 7 patients in the control group.In Hunt-Hess III and IV patients,the incidence of acute hydrocephalus was 13.2%and 36.4%,and the incidence of shunt dependent hydrocephalus was 7.9%and 15.9%.In patients with ventricular hemorrhage,the incidence of shunt dependent hydrocephalus was 7.9%.The incidence of flow dependent hydrocephalus was 5.9%and 15.8%respectively.Conclusion Lamina terminalis fenestration combined with lumbar cistern drainage can reduce the incidence of acute hydrocephalus.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 脑积水 终板造瘘 腰池引流 

分 类 号：R651.1[医药卫生—外科学]