分流管在中枢神经系统结核并发脑积水中的治疗作用分析  

Therapeutic Effect Analysis of Shunt Catheter in Central Nervous System Tuberculosis Complicated with Hydrocephalus

作　　者：俞珊 李志明 杨荔慧 段浩凯 梁蕾 王涛 YU Shan;LI Zhiming;YANG Lihui;DUAN Haokai;LIANG Lei;WANG Tao(The Fourth Ward of Tuberculosis Department,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China;Department of Radiology,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China)

机构地区：[1]中国人民解放军总医院第八医学中心结核科四病区,北京100091 [2]中国人民解放军总医院第八医学中心放射科,北京100091

出　　处：《中国医疗设备》2022年第5期10-14,共5页China Medical Devices

基　　金：“十三五”国家科技重大专项(2018ZX10725509)。

摘　　要：目的探讨分流管在中枢神经系统结核(Central Nervous System Tuberculosis,CNS-TB)并发脑积水中的治疗作用。方法回顾性分析因CNS-TB并发脑积水采用分流管行脑室腹腔分流术的21例患者的临床资料,分析分流管在脑室腹腔分流术中的治疗作用。分为采用可调压分流管行脑室腹腔分流术(简称脑腹分流组)7例,先采用中压抗虹吸分流管行脑室腹腔分流+腹腔端旷置术,再采用可调压分流管行脑室腹腔分流术(简称联合组)6例,采用中压抗虹吸分流管行脑室腹腔分流+腹腔端旷置术(简称旷置组)8例。结果脑腹分流组6例有效,1例死亡;联合组6例均有效;旷置组4例有效,4例无效,其中1例死亡;手术总有效率为76.19%。治疗有效患者的术前腰穿压力、脑脊液白细胞数、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、并发症与治疗无效患者相比,差异有统计学意义(P<0.05)。结论采用分流管行脑室腹腔分流术对CNS-TB并发脑积水的治疗有积极的效果,而术前腰穿压力偏低、脑脊液白细胞数较多、GCS评分较低及出现术后并发症的患者手术疗效差。Objective To explore the therapeutic effect of shunt catheter in central nervous system tuberculosis(CNS-TB)complicated with hydrocephalus.Methods The clinical data of 21 patients with CNS-TB complicated with hydrocephalus and undergoing ventriculoperitoneal shunt(VPS)with shunt catheter were analyzed.The therapeutic effect of shunt catheter in VPS were analyzed.Seven cases underwent VPS with adjustable pressure shunt catheter(brain-abdomen shunt group for short),6 cases underwent VPS andventral exclusion with medium pressure anti-siphon shunt catheter first,then underwent VPS with adjustable pressure shunt catheter later(combined group for short),and 8 cases underwent VPS and ventral exclusion with medium pressure anti-siphon shunt catheter(ventral exclusion group for short).Results Six cases were effective and one case died in the brain-abdomen shunt group.Six cases in combined group were all effective.Four cases were effective,four cases were ineffective,and 1 case died in the ventral exclusion group.The total effective rate was 76.19%.The analysis of variance showed that the preoperative lumbar puncture pressure,leukocyte countofcerebrospinal fluid,Glasgow coma scale(GCS)score and complications of patients with effective treatment were significantly different from those of patients with ineffective treatment(P<0.05).Conclusion VPS has a positive effect on the treatment of CNS-TB complicated with hydrocephalus,while the patients with low lumbar puncture pressure,high leukocyte count in cerebrospinal fluid,low GCS score and postoperative complications have poor surgical effect.

关 键 词：脑室腹腔分流术 中枢神经系统结核 脑积水 中压抗虹吸分流管 可调压分流管 

分 类 号：R197.39[医药卫生—卫生事业管理]