脑室镜结合腹腔镜下脑室腹膜分流术对脑积水患者的治疗效果及对炎性因子、免疫功能的影响  

The effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt on the treatment effect,inflammatory factors and immune function in patients with hydrocephalus

作　　者：陈杰 孔娟 刘杨 Chen Jie;Kong Juan;Liu Yang(Department of Neurosurgery,Traditional Chinese Medicine Hospital of Jining,Shandong Jining 272000,China;Department of Ear,Nose and Throat,Traditional Chinese Medicine Hospital of Jining,Shandong Jining 272000,China;Department of Gynecology,Yankuang New Journey General Hospital,Shandong Zoucheng 273500,China)

机构地区：[1]山东省济宁市中医院神经外科,272000 [2]山东省济宁市中医院耳鼻喉科,272000 [3]山东省兖矿新里程总医院妇科,山东邹城273500

出　　处：《中国医师进修杂志》2021年第12期1072-1077,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨脑室镜结合腹腔镜下脑室腹膜分流术(VPS)对脑积水患者的治疗效果及对炎性因子、免疫功能的影响。方法收集2017年3月至2019年9月山东省济宁市中医院诊治的76例脑积水患者的临床资料,按照治疗术式不同分为观察组(39例)和对照组(37例)。对照组施行传统VPS,观察组施行脑室镜结合腹腔镜下VPS。比较两组术后并发症发生率、术后6个月治疗效果,比较术前和术后1、3 d血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)]和免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平,比较术前和术后3、6个月格拉斯哥预后量表(GOS)、改良Rankin量表(MRS)、美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、生命质量综合评定问卷(GQOL-74)评分。结果观察组术后6个月总有效率高于对照组[94.9%(37/39)比73.0%(27/37)],差异有统计学意义(χ^(2)=6.848,P<0.05)。观察组术后3、6个月GOS评分高于对照组[(3.68±0.49)分比(3.02±0.51)分、(4.17±0.24)分比(3.59±0.43)分],MRS、NIHSS评分低于对照组[(2.05±0.15)分比(2.84±0.17)分和(1.62±0.11)分比(2.17±0.14)分比、(12.97±3.82)分比(16.05±4.61)分、(10.90±2.75)分比(13.84±3.29)分],差异均有统计学意义(P<0.05)。观察组术后1、3 d血清TNF-α、IL-6水平低于对照组,IL-10水平高于对照组,差异均有统计学意义(P<0.05)。观察组术后1、3 d CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组[10.3%(4/39)比29.7%(11/37)],差异有统计学意义(χ^(2)=4.383,P<0.05)。观察组术后3、6个月BI、GQOL-74评分高于对照组,差异有统计学意义(P<0.05)。结论脑室镜结合腹腔镜下VPS应用于脑积水患者,通过减轻炎性应激反应,降低对免疫功能的影响,有助于减少术后并发症的发生,进一步促进预后改善。Objective To investigate the therapeutic effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt(VPS)on the treatment effect,inflammatory factors and immune function in patients with hydrocephalus.Methods A retrospective study was conducted on 76 patients with hydrocephalus in Traditional Chinese Medicine Hospital of Jining from March 2017 to September 2019,and they were divided into observation group(39 cases)and control group(37 cases)according to different treatment procedures.The control group performed traditional VPS,and the observation group performed ventricoscopy combined with laparoscopy in VPS.The incidence of postoperative complications and the treatment effect at 6 months after the operation,serum inflammatory factors tumor necrosis factor-α(TNF-α),interleukin(IL)-10,IL-6,immune function indexes CD3^(+),CD4^(+),CD4^(+)/CD8^(+)before and 1 d and 3 d after the operation,Glasgow Outcome Scale(GOS)and Modified Rankin Scale(MRS),National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI)and Generic Quality of Life Inventory 74(GQOL-74)before operation,3 and 6 months after operation were compared between the two groups.Results The total effective rate in the observation group at 6 months after operation was higher than that in the control group:94.9%(37/39)vs.73.0%(27/37),and the difference was statistically significant(χ^(2)=0.848,P<0.05).The GOS scores in the observation group were higher than those in the control group at 3 months and 6 months after surgery:(3.68±0.49)scores vs.(3.02±0.51)scores,(4.17±0.24)scores vs.(3.59±0.43)scores;and the MRS and NIHSS scores were lower than those in the control group:(2.05±0.15)scores vs.(2.84±0.17)scores and(1.62±0.11)scores vs.(2.17±0.14)scores,(12.97±3.82)scores vs.(16.05±4.61)scores and(10.90±2.75)scores vs.(13.84±3.29)scores;and the differences were statistically significant(P<0.05).The serum levels of TNF-αand IL-6 in the observation group were lower than those in the control group at 1 and 3 d after surgery,an

关 键 词：脑积水 脑室腹膜分流术 腹腔镜 脑室镜 炎症趋化因子类 免疫因子 

分 类 号：R651.1[医药卫生—外科学]