脑出血术后慢性脑积水患者CT影像特征及ETV与VPS的治疗效果比较  

CT imaging features of patients with chronic hydrocephalus after intracerebral hemorrhage and comparison of therapeutic effects of ETV and VPS

作　　者：张帅 潘强 刘振瑞 姜宗飞 司锋 李逢佳 宋纯玉 Zhang Shuai;Pan Qiang;Liu Zhenrui;Jiang Zongfei;Si Feng;Li Fengjia;Song Chunyu(Department of Neurosurgery,the People′s Hospital of Jinan&the People′s Hospital Affiliated to Shandong First Medical University,the Key Laboratory of Neurotumor Molecular Biology of Jinan,Jinan 250102,China)

机构地区：[1]山东第一医科大学附属人民医院(济南市人民医院)神经外科,济南市神经肿瘤分子生物学重点实验室,济南250102

出　　处：《中国医师杂志》2025年第2期210-214,219,共6页Journal of Chinese Physician

基　　金：山东省医药卫生科技发展计划项目(202104040585);济南市卫生健康委科技计划项目(2023-2-32)。

摘　　要：目的探讨脑出血手术后发生慢性脑积水患者的CT影像学特征及采用内镜下第三脑室底造瘘术(ETV)与脑室-腹腔分流术(VPS)治疗的效果差异。方法回顾性选取2021年1月-2023年6月在济南市人民医院神经外科接受手术治疗的158例脑出血患者为研究对象,其中手术后出现慢性脑积水的患者78例作为脑积水组,手术后未发生脑积水的80例患者作为非脑积水组,统计分析患者的CT影像学资料。将脑积水组患者根据治疗方式不同分为ETV组(42例)和VPS组(36例),比较两组患者的疗效和生活质量,统计两组并发症发生情况。结果脑积水组患者的脑出血部位、血肿形态及混杂征、分叶征、黑洞征患者占比与非脑积水组比较,差异均无统计学意义(均P>0.05);脑积水组脑室扩张、血肿扩大患者占比显著高于非脑积水组(均P<0.05)。连续测定两组脑积水患者在不同时间点的美国国立卫生研究院卒中量表(NIHSS)评分,ETV组和VPS组治疗前、治疗2周、4周时的NIHSS评分差异均无统计学意义(均P>0.05);ETV组和VPS组患者治疗后的疗效对比,差异无统计学意义(P>0.05);ETV组的术后复发率低于VPS组(P<0.05);ETV组患者术后3个月、6个月的生活质量得分均高于VPS组(均P<0.05)。结论脑出血术后发生慢性脑积水的患者CT检查会出现明显的血肿扩大、脑室扩张特征。ETV与VPS治疗脑出血手术后发生慢性脑积水患者效果相当,但是前者复发率更低、术后生存质量更高。ObjectiveTo investigate the computed tomography(CT)imaging features of patients with chronic hydrocephalus after intracerebral hemorrhage surgery and the difference between endoscopic third ventriculostomy(ETV)and ventricular peritoneal shunt(VPS).MethodsA total of 158 patients with intracerebral hemorrhage who received surgical treatment in the Department of Neurosurgery of the People′s Hospital of Jinan from January 2021 to June 2023 were retrospectively selected as the study objects,including 78 patients with chronic hydrocephalus after surgery as the hydrocephalus group,and 80 patients with no hydrocephalus after surgery as the non-hydrocephalus group,and the CT imaging data of the patients were statistically analyzed.Hydrocephalus group was divided into ETV group(42 cases)and VPS group(36 cases)according to different treatment methods.The efficacy and quality of life of the two groups were compared,and the incidence of complications in the two groups were counted.ResultsThere was no significant difference between hydrocephalus group and non-hydrocephalus group in the site of cerebral hemorrhage,hematoma morphology and the proportion of patients with mixed signs,lobular signs and black hole signs(all P>0.05).The proportion of patients with ventricular dilation and hematoma enlargement in hydrocephalus group was significantly higher than that in non-hydrocephalus group(all P<0.05).The National Institute of Health Stroke Scale(NIHSS)scores of hydrocephalus patients in the two groups were measured continuously at different time points,and there was no significant difference in NIHSS scores between the ETV group and the VPS group before treatment,at 2 weeks and 4 weeks of treatment(all P>0.05).There was no significant difference between the ETV group and the VPS group(P>0.05).The recurrence rate of the ETV group was lower than that of the VPS group(P<0.05).The quality of life scores of patients in ETV group were higher than those in the VPS group at 3 months and 6 months after surgery(P<0.05).ConclusionsCT exam

关 键 词：脑出血 脑积水 计算机体层摄影术 第三脑室底造瘘术 脑室-腹腔分流术 

分 类 号：R65[医药卫生—外科学]