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内窥镜第三脑室底造瘘治疗梗阻性脑积水的临床观察

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摘要 目的探讨神经内窥镜下第三脑室底造瘘(endoscopic third ventriculostomy,ETV)治疗梗阻性脑积水患者的手术方法,根据随访结果对ETV手术进行客观的临床评估.方法对于13例因不同原因造成的梗阻性脑积水患者进行了ETV手术治疗.其中对1例成人患者和1例小儿患者加用了中脑导水管球囊扩张术.结果随访1~48个月,随访结果示该手术明显有效9例.其中2例同时做了导水管扩张术.1例患者同时合并有骶裂、骶部皮毛窦及腰4椎管内占位、脑膜炎.控制感染后成功完成了椎管内肿瘤切除术+ETV,术后症状未见明显好转.1例小儿患者术中发现合并有脑室内持久性出血,术后3个月行脑室-腹腔分流术治疗.另1例因松果体区肿瘤所致脑积水的患者术中发现合并有三脑室底部下陷,为避免基底动脉损伤而放弃了造瘘术,行γ-刀放疗后6个月改用脑室-腹腔分流术治疗.1例18岁男性患者术中造瘘时动脉出血而不得不终止手术.本组无死亡病例.结论对于梗阻性脑积水的患者来说,ETV是一种安全有效的外科治疗方法.随着神经内窥镜设备的不断改进、技术的改善和提高,ETV手术有可能替代分流术而成为治疗梗阻性脑积水的首选方法.
出处 《山西医科大学学报》 CAS 2005年第6期743-745,共3页 Journal of Shanxi Medical University
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