基于倾向得分匹配法比较腹腔镜技术与传统开腹手术治疗脑积水的安全性和预后  

Comparative analysis of the safety and prognosis of laparoscopic technique and traditional laparotomy in the treatment of hydrocephalus based on propensity score matching

作　　者：尚玮 王长淼[2] 费明杨 周冠臣 董斌[1] SHANG Wei;WANG Changmiao;FEI Mingyang;ZHOU Guanchen;DONG Bin(Department of Neurosurgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116000,China;Department of Acute Abdominal Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第一医院神经外科,辽宁大连116000 [2]大连医科大学附属第一医院腹部急症外科,辽宁大连116000

出　　处：《大连医科大学学报》2024年第6期497-502,共6页Journal of Dalian Medical University

基　　金：大连市医学科学研究计划项目(登峰计划)(2023DF015)。

摘　　要：目的比较腹腔镜技术与传统开腹手术治疗脑积水的安全性和远期预后。方法收集大连医科大学附属第一医院神经外科自2022年1月至2024年1月收治的行脑室腹腔分流手术(VPS)的93例脑积水患者的临床资料和随访数据,依据术中是否采用腹腔镜辅助分为常规开腹组(72例)和腹腔镜辅助组(21例)。再按一般临床资料进行1∶1倾向得分匹配,最终腹腔镜辅助组和常规开腹组分别纳入18例患者。比较匹配后两组患者一般临床资料、手术相关指标、术后并发症、临床和影像学随访结果的差异。结果匹配前,腹腔镜辅助组患者脑室穿刺位点为额角的比例(85.7%)明显高于常规开腹组(55.6%),差异有统计学意义(P<0.05)。匹配后,两组患者一般及临床资料差异均无统计学意义(P>0.05);腹腔镜组患者术中腹腔端操作时间[(12.94±2.73)min vs(18.44±3.76)min]、术后卧床时间[(7.33±2.57)d vs(10.28±2.49)d]和住院时间[(2.39±0.85)d vs(3.44±1.04)d]均明显短于常规开腹组,差异有统计学意义(P<0.05);两组手术总时间、术后并发症差异无统计学意义(P>0.05)。术后3个月腹腔镜组患者胼胝体角度为(95.56±11.87)°,明显高于常规开腹组的(87.39±11.04)°,差异有统计学意义(P<0.05);两组患者术后3个月Karnofsky功能状态(KPS)评分、日常生活活动能力(ADL)评分、Evans指数差异均无统计学意义(P>0.05)。结论使用腹腔镜辅助进行脑积水手术在保证较低并发症发生率的同时可以改善患者预后,其微创、精准的优点值得更广泛的临床推广和应用。Objective To compare the safety and long-term prognosis of laparoscopic technique with traditional laparotomy in the treatment of hydrocephalus.Methods The clinical,imaging and follow-up data of hydrocephalus patients,who underwent ventriculoperitoneal shunt surgery in the Department of Neurosurgery at the First Affiliated Hospital of Dalian Medical University from January 2022 to January 2024,were collected.Based on whether laparoscopic assistance was used during the surgery,the patients were divided into conventional open surgery group(n=72)and laparoscopy-assisted group(n=21).Further 1∶1 propensity score matching was performed based on general clinical data,and ultimately 18 patients were included in the laparoscopy-assisted group and the conventional open surgery group,respectively.The general clinical data,surgery-related indicators,surgical complications,clinical and imaging follow-up results were compared between the two groups after matching.Results Before matching,the proportion of patients undergoing ventricular puncture at the frontal horn was significantly higher in the laparoscopy-assisted group(85.7%)compared to the conventional open surgery group(55.6%),and the difference was statistically significant(P<0.05).After matching,there were no statistically significant differences in general clinical characteristics between the two groups(P>0.05).Following matching,the laparoscopy-assisted group had significantly shorter intraoperative abdominal end manipulation time[(12.94±2.73)min vs(18.44±3.76)min],postoperative bed rest time[(7.33±2.57)days vs(10.28±2.49)days],and hospital stay[(2.39±0.85)days vs(3.44±1.04)days]compared to the conventional open surgery group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the total operation time and postoperative complications between the two groups(P>0.05).Long-term follow-up results showed that the corpus callosum angle was significantly higher in the laparoscopy-assisted group[(95.56±11.87)�

关 键 词：脑积水 腹腔镜 脑室腹腔分流术 倾向得分匹配 

分 类 号：R651.1[医药卫生—外科学]