侧脑室-腹腔分流术后或同期行颅骨修补术继发硬膜外积液的危险因素和疗效分析  

Risk factors and therapeutic effect of epidural fluid collection as a complication of cranioplasty after or during ventriculoperitoneal shunting

作　　者：张尚明 李松远 陈宏颉 魏梁锋 袁邦清 王守森 Zhang Shangming;Li Songyuan;Chen Hongjie;Wei Liangfeng;Yuan Bangqing;Wang Shousen(Department of Neurosurgery.the 900th Hospital of the Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]解放军联勤保障部队第九〇〇医院神经外科,福州350025

出　　处：《中华神经外科杂志》2020年第11期1165-1169,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨侧脑室-腹腔分流术后或同期行颅骨修补术继发大量硬膜外积液(EFC)的相关危险因素和疗效。方法回顾性分析2014年6月至2019年6月解放军联勤保障部队第九〇〇医院神经外科采用钛网行颅骨修补术,且于修补术前或同期行侧脑室-腹腔分流术患者的临床资料,共59例。颅骨修补术后33例继发EFC,其中7例为症状性EFC(SEFC)。EFC患者均采用去枕平卧及增加补液量治疗;SEFC患者采用头皮穿刺钛网抽吸并持续引流积液3~5 d,结合去枕平卧、增加补液量以及调高分流阀压力的治疗方式。观察患者的临床疗效,采用多因素logistic逐步回归法分析EFC的相关危险因素。结果治疗后33例EFC患者积液均吸收,其中26例非SEFC患者积液吸收时间为(25.1±6.2)d,7例SEFC患者积液的吸收时间为(12.7±1.8)d,差异有统计学意义(t=8.906,P<0.05)。33例患者的随访时间为3~6个月,无一例患者EFC复发。与26例无EFC组比较,EFC组的分流阀压力差大[分别为(60.0±8.9)mmH2O、(65.9±9.1)mmH2O,1 mmH2O=0.0098 kPa],假性脑膜悬吊的比例低[分别为76.9%(20/26)、45.5%(15/33)],差异均有统计学意义(均P<0.05);多因素logistic回归分析显示,分流阀压力差大(OR=1.079,95%CI:1.010~1.154,P=0.025)和未行假性脑膜悬吊(OR=4.169,95%CI:1.251~13.900,P=0.020)是EFC发生的危险因素。结论对于已行或同期行侧脑室-腹腔分流术的患者进行颅骨修补时,术前调高分流阀压力以及在术中行假性脑膜悬吊可减少EFC的发生率,对已经形成积液的患者有助于积液的吸收。Objective To explore the risk factors and therapeutic effect of epidural fluid collection(EFC)as a complication of cranioplasty after or during ventriculoperitoneal(VP)shunting.Methods Fifty-nine patients who underwent cranioplasty with titanium mesh after or during VP shunting from June 2014 to June 2019 were reviewed at Department of Neurosurgery,the 900th Hospital of the Joint Logistics Team.There were 33 patients who developed the complication of EFC after operation,7 of which were symptomatic EFC(SEFC).Supine position and increased rehydration were prescribed to all patients.In addition,the patients with SEFC underwent percutaneous puncture and continuous negative pressure external drainage for 3-5 days and the pressure of the shunt valve was increased.We observed the therapeutic effect and analyzed the risk factors associated with EFC.Results The effusion of 33 patients was absorbed after treatment.Among them,the absorption time of effusion in 26 non-SEFC patients was 25.1±6.2 d and that in 7 patients with SEFC was 12.7±1.8 d.The difference was statistically significant(t=8.906,P<0.05).None of the patients had EFC recurrence during follow-up lasting for 3-6 months.Compared with non-SEFC subgroup,the pressure of shunt valve in EFC subgroup was higher(65.9±9.1 mmH2O vs.60.0±8.9 mmH2O)and the proportion of meningeal suspension was lower[45.5%(15/33)vs.76.9%(20/26)].There was significant difference between the 2 subgroups(P<0.05).Multivariate logistic regression analysis showed that higher pressure of shunt valve(OR=1.079,95%CI:1.010-1.154,P=0.025)and no meningeal suspension(OR=4.169,95%CI:1.251-13.900,P=0.020)were risk factors for EFC.Conclusion For cranioplasty in patients who have undergone VP shunting or undergo simultaneous shunting,increasing the pressure of the shunt valve before operation and performing the meningeal suspension during operation could reduce the chance of EFC and its absorption in those who have developed EFC.

关 键 词：颅骨修补术 脑室腹膜分流术 硬脑膜外积液 危险因素 

分 类 号：R651.1[医药卫生—外科学]