脑室-腹腔分流术治疗重度结核性脑积水(附17例报告)

Ventriculoperitoneal shunting for servere tuberculous hydrocephalus(report of 17 cases)

目的探讨脑室-腹腔分流术治疗重度结核性脑积水(TBH)的时机和效果。方法自2007年1月至2012年4月行脑室-腹腔分流术(VPS)治疗重度TBH患者17例,其中Vellore分级Ⅱ级1例,Ⅲ级13例,Ⅳ级3例;VPS前均进行脑室外引流术(EVD)。结果EVD后,所有患者脑脊液糖含量、白细胞数等指标明显降低(P<0.05),而蛋白质浓度变化不明显(P>0.05)。VPS后患者意识状态较术前明显改善。VPS后1月按GOS评分评估预后,5分4例(术前均为VelloreⅢ级者),4分8例(术前VelloreⅡ级1例,Ⅲ级5例,Ⅳ级2例),3分4例(术前均为VelloreⅡ级者1例),死亡1例(术前均为VelloreⅣ级者)。死亡病例是因为VPS后分流阀堵塞致病情加重而死亡,其他患者无严重并发症。结论EVD可为重度TBH患者实施VPS创造有利的脑脊液条件。脑室-腹腔分流系统可改善TBH患者的预后。

Objective To study the clinical effect of ventriculoperitoneal shunting （VPS） on severe tuberculous hydrocephalus （TBH） and its opportunity. Methods The clinical data of 17 patients with TBH, who underwent VPS from January, 2007 to April, 2012, were analyzed retrospectively. External ventricular drainage （EVD） was performed in all the patients before VPS in order to improve the condition of the cerebral spinal fluid （CSF）. Results The indexes of CSF including glucose and leucocytes except protein content significantly improved after EVD compared to before EVD （P〈0.05）. The conscious state significantly improved one week after VPS compared with before VPS. Of 17 patients, 8 patients recovered well （GOS 4-5 scores）, 14 were moderately disabled （GOS 3 scores） and 4 severely disabled （GOS 2 scores）, and 1 died. Conclusions EVD can provide the opportunity for VPS by improving the CSF in patients with TBH. The VPS is an effective method to treat TBH.