脑室-腹腔分流术联合颅骨修补术同期治疗脑积水合并颅骨缺损的临床应用研究

Clinical Application of Ventriculo-peritoneal Shunt Combined with Cranioplasty in the Simultaneous Treatment of Hydrocephalus with Skull Defect

目的探讨同期实施脑室-腹腔分流术(ventriculo-peritoneal shunt,VPS)联合颅骨修补术治疗脑积水合并颅骨缺损患者的临床疗效。方法应用病例对照研究方法,回顾性分析2014年1月至2015年12月同期实施脑室-腹腔分流术联合颅骨修补术的脑积水合并颅骨缺损患者的临床资料(同期组,40例),及2012年1月至2013年12月分期实施脑室-腹腔分流术与颅骨修补术的脑积水合并颅骨缺损患者的临床资料(分期组,40例),比较两组患者手术治疗效果。结果同期组手术时间短于分期组( P <0.05),但同期组住院费用与分期组比较差异无统计学意义( P >0.05;同期组术后脑积水程度、术后脑灌注异常指数较术前均有改善( P <0.05),分期组脑积水程度与术前比较有改善( P <0.05),但术前及术后脑灌注异常指数比较差异无统计学意义( P >0.05)。两组患者手术治疗后脑灌注异常指数、脑积水程度比较差异无统计学意义( P >0.05;两组术后Salmon 预后有效率比较差异无统计学意义( P >0.05;同期组并发症发生率少于分期组( P <0.05)。结论同期实施脑室-腹腔分流术联合颅骨修补术治疗脑积水合并颅骨缺损患者的临床疗效与分期手术相当,因同期手术具有手术时间短、并发症发生率低的优点,更利于患者术后恢复。

Objective To investigate the clinical efficacy of ventriculo-peritoneal shunt (VPS) combined with cranioplasty in the treatment of hydrocephalus with skull defect.Methods The case-control study method was used to retrospectively analyze the clinical data of 40 patients with hydrocephalus complicated with skull defect who underwent the simultaneous operation of VPS combined with cranioplasty from January of 2014 to December of 2015 and divided into the simultaneous operation group and the other 40 patients with hydrocephalus complicated with skull defect who underwent the staged operation of VPS and cranioplasty from January of 2012 to December of 2013 and divided into the staged operation group.The clinical efficacy of operation was compared between the two groups.Results The operative time of the simultaneous operation group was significantly shorter than that of the staged operation group ( P <0.05), while there was no significant difference in the hospitalization expense between the two groups ( P >0.05).The degree of hydrocephalus and the abnormal index of cerebral perfusion after operation were significantly improved compared with those before operation in the simultaneous operation group ( P <0.05).The degree of hydrocephalus was significantly improved after operation in the staged operation group( P <0.05), while there was no significant difference in the abnormal index of cerebral perfusion between before and after operation.There was no significant difference in the degree of hydrocephalus, abnormal index of cerebral perfusion prognostic efficacy after operation between the two groups ( P >0.05).The incidence of complications in the simultaneous and salmon operation group was significantly lower than that in the staged operation group ( P <0.05).Conclusion The simultaneous operation of VPS combined with cranioplasty has the same clinical efficacy as the staged operation of VPS combined with cranioplasty, but the simultaneous operation is more conducive to the postoperative recovery of patients as its operation time is shorter and its incidence of complications is lower.