可调压分流管腰大池腹腔分流术治疗创伤后脑积水的临床疗效及对远期预后的影响  

Influences of Lumboperitoneal Shunts on Clinical Efficacy and Long-term Prognosis in the Treatment of Post-traumatic Hydrocephalus

作　　者：陈昌 吴章泽 王一芳 王正伟 CHEN Chang;WU Zhangze;WANG Yifang;WANG Zhengwei(Air Force Hospital of Eastern Theater Command of Chinese People′s Liberation Army,Nanjing 210000,Jiangsu,China)

机构地区：[1]东部战区空军医院,南京210000

出　　处：《中西医结合心脑血管病杂志》2020年第21期3688-3691,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：2015年度军区医学科技创新课题项目(No.15MS075)。

摘　　要：目的观察可调压分流管腰大池腹腔分流术(LPS)治疗创伤后脑积水(PTH)的临床疗效,并随访观察其远期预后。方法回顾性分析本院80例PTH病人的临床资料,其中44例行可调压分流管LPS治疗,作为A组,36例行侧脑室腹腔分流术(VPS)治疗,作为B组。比较两组手术一次成功率、神经功能缺损情况、日常生活能力、临床疗效、并发症发生情况、远期预后情况。结果A组手术一次成功率高于B组(95.45%与80.56%,P<0.05);术前两组加拿大神经病学量表(CNS)、改良Rankin量表(mRS)分数比较差异均无统计学意义(P>0.05),术后两组CNS评分均较术前升高(P<0.05),mRS评分均较术前降低(P<0.05),但两组术后CNS评分、mRS评分比较差异均无统计学意义(P>0.05);A组、B组临床总有效率比较差异无统计学意义(90.91%与80.56%,P>0.05);A组并发症发生率明显低于B组(11.36%与33.33%,P<0.05);A组远期预后良好率明显高于B组(81.82%与61.11%,P<0.05)。结论PTH治疗中可调压分流管LPS与VPS均可改善病人神经功能、日常生活能力,临床疗效相当,但可调压分流管LPS手术一次成功率更高,并发症更少,远期预后更好。Objective To observe the clinical efficacy and the long-term prognosis.of lumboperitoneal shunts(LPS)in the treatment of post-traumatic hydrocephalus(PTH)patients.Methods The clinical data of 80 patients with PTH in our hospital were retrospectively analyzed.Forty-four patients underwent LPS with adjustable pressure shunt,as group A.Thirty-six patients underwent lateral ventriculo-peritoneal shunt(VPS)treatment as group B.The success rate,neurological deficits,daily living ability,clinical efficacy,and complication were evaluated and compared.The long-term prognosis of two groups was compared by follow-up.Results The success rate of group A was significantly better than that of group B(95.45%vs 80.56%,P<0.05).There were no significant differences between two groups in the Canadian Neurological Scale(CNS)and modified Rankin scale(mRS)before operation(P>0.05).After operation,The CNS scores of two groups were significantly increased(P<0.05),and the mRS scores were significantly reduced(P<0.05).There were no significant differences of CNS scores and mRS scores between two groups(P>0.05).There was no significant difference in the efficiency between two groups(90.91%vs 80.56%,P>0.05).The incidence of complications in group A was significantly lower than that in group B(11.36%vs 33.33%,P<0.05).The long-term prognosis of group A was significantly better than that in group B(81.82%vs 61.11%,P<0.05).Conclusion The adjustable pressure shunt LPS and VPS both can improve the neurological function and daily living ability of patients with PTH.The clinical effect is comparable,but there are higher success rate,fewer complications,and better long-term prognosis in LPS.

关 键 词：创伤后脑积水 可调压分流管 腰大池腹腔分流术 远期预后 神经功能缺损 日常生活能力 

分 类 号：R651.15[医药卫生—外科学] R269[医药卫生—临床医学]