低压和负压性脑积水的诊治分析  

Diagnosis and treatment of low pressure and negative pressure hydrocephalus

作　　者：张训[1] 秦明筠[1] 谢清 饶英华 Zhang Xun;Qin Mingjun;Xie Qing;Rao Yinghua(Department of Neurosurgery,the Affiliated Brain Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510370,China)

机构地区：[1]广州医科大学附属脑科医院神经外科,510370

出　　处：《中国微侵袭神经外科杂志》2020年第5期212-215,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨低压性脑积水(low pressure hydrocephalus,LPH)和负压性脑积水(negative pressure hydrocephalus,NegPH)的临床表现、发病机制、诊断及治疗方法。方法回顾性分析15例LPH和NegPH病人的临床资料,经脑室外引流测压确诊6例,经腰椎穿刺测压确诊2例,经储液囊穿刺测压确诊7例。8例初发LPH病人采用可调压分流管行脑室-腹腔分流术(ventriculo-peritoneal shunt,VPS),5例分流术后LPH病人予以调节可调压分流管或更换为可调压分流管,2例分流术后NegPH病人将分流管末端放置在胸腔或心房。结果 15例随访12~36个月,均未出现颅内感染;脑积水引起的临床症状完全改善10例,部分改善4例,无改善1例;脑室周围渗出消失或明显减轻11例,稍减轻3例,无变化1例;脑室大小恢复至正常9例,较术前缩小4例,无明显变化2例;脑脊液蛋白降至正常11例,仍偏高4例。结论对LPH病人采用可调压分流管行VPS疗效确切,而NegPH需要采用特殊的分流方法。Objective To explore the clinical manifestations, pathogenesis, diagnosis and treatment of low pressure hydrocephalus(LPH) and negative pressure hydrocephalus(NegPH). Methods Clinical data of 15 patients with LPH or NegPH were analyzed retrospectively. Six patients were diagnosed by measuring the pressure of extraventricular drainage, 2 by measuring the pressure of lumbar puncture and 7 by measuring the pressure of fluid reservoir puncture. Eight patients with initial LPH underwent ventriculoperitoneal shunt(VPS) with adjustable pressure shunt pipe, 5 with LPH after VPS were treated with adjustable pressure shunt pipe or replaced with adjustable pressure shunt pipe, and 2 with NegPH after VPS placed the end of the shunt pipe in the chest or atrium. Results Fifteen patients were followed up for 12 to 36 months, no patient sufferred intracranial infection. The clinical symptoms caused by hydrocephalus were completely improved in 10 patients, markedly improved in 4 and had no improvement in 1 patient. Periventricular exudation disappeared or obviously alleviated in 11 patients, decreased slightly in 3 and unchanged in 1. The size of ventricles returned to normal level in 9 patients, decreased in 4 and unchanged in 2. The cerebrospinal fluid protein decreased to normal in 11 patients and remained high in 4. Conclusion VPS with pressure-adjustable valves is effective for PLH, while special shunt method should be applied for NegPH.

关 键 词：脑积水 低压性(或负压性) 诊断 脑室-腹腔分流术 压力调节阀 

分 类 号：R742.7[医药卫生—神经病学与精神病学]