Ommaya储液囊治疗重型颅脑外伤术后颅内感染合并脑积水

Using of Ommaya reservoir in postoperative intracraniai infection combined with hydrocephalus in patients with severe traumatic brain injury

目的 探讨Ommaya储液囊对重型颅脑外伤术后颅内感染合并腑积水的治疗作用及其优越性。方法 将34例重型颅脑外伤术后颅内感染合并脑积水忠者随机分组，其中Ommaya治疗组13例，脑室外引流组21例，比较两组24h平均引流量、首次置泵（管）至施行永久性分流术的平均时间、二次手术率、分流率，并进行3个月格拉斯哥预后评分（GOS）。结果 Ommaya治疗组24h平均引流量少于脑室外引流组；首次置泵至施行永久性分流术的平均时间为（57．00±8．06）d，较脑室外引流组首次置管至施行永久性分流术平均时间（66．00±6．89）d缩短；Ommava治疗组完成脑室腹腔分流术患者10例，放弃治疗3例，分流率76．9％；治疗期间再次手术更换Ommaya储液囊4例，二次手术率30．8％（4／13）。脑室外引流组最终完成脑室腹腔分流术患者13例，放弃治疗3例，死亡5例，分流率61．9％；治疗期间再次手术置管16例，二次手术率为76．2％（16／21）。两组分流率及随访3个月GOS评定差异均无统计学意义（P〉0．05）。结论 Ommaya储液囊应用于重型颅脯外伤术后颅内感染合并脑积水，与传统脑室外引流术比较，临床分流率相似，但治疗期间二次手术率低，且能减少治疗天数，值得临床推广。

Objective To investigate the treatment function arid dominmance of Ommaya reservoir, which was used to treat postoperative intracranial infection comnbined with hydrocephahms in patients with severe traumatic brain injury. Methods Thirty-four patients suffered intracranial infection combined with hydrocephalus after operatiomms. They were randomly divided into 2 groups.Thirteeu patients were treated with Ommaya reservoir, the others were treated with external ventricular drainage. The 24-hour mean drain quantum, the mean days from implanlation pumps or tubes to ventriculo-peritoneal （V-P） shunt operatiou, the rate of secondary operation and the rate of getting V-P shunt operation were analyzed, then the Glasgow outcome scale （GOS） of patients were observed at 3 mouths. Results Comnpared with patients treated with external ventriular drainage, patients with Omnmaya reservoir had the less24-hour mean drain quantunm and shorten time to get the V-P shunt operation, the nlean days fronl implantation pumps to get V-P shunt was （57.00± 8.06 ） days. In 13 patients with Ommaya reservoir, 10 patients finished V-P shunt operation finally, 3 patients gave Up the shmmt operation, shunt rate was 76.9%.In the Ireatnmenl period , 4 palielmts had to change the Ommaya reservoir, secondary operation rate was 30.8%. Thirteen patients had the chance to get V-P shunt operation among 21 patients which got external ventrictmlar drainage, 3 patients gave up the shunt operation, 5 patients died, shunt rate was 61.9%, 16 patients changed the ventric,mlar drainage tube, sec- ondary operation rate was 76.2%. There was no significant difference itm 3-monlh GOS between them （P 〉 0.05 ）. Conclusions Compared with external ventricular drainage, Omnmaya reservoir has similar shunt rate. Ommaya reservoir has the less secondary operation rate, shorten the treatment days postoperative intracranial infection combined with hydrocephalus in patients with severe traumatic brain injury, so it should be popu-larized in clinic.