创伤后脑积水合并严重意识障碍患者侧脑室-腹腔分流术的疗效

Effect of ventricle-peritoneal shunt in treatment of patients with post-traumatic hydrocephalus combined with severe consciousness disturbance

目的 探讨对于因创伤性脑损伤（traumatic brain injury,TBI）程度过重而无法表现出脑积水症状或表现为非典型症状的创伤后脑积水（post-traumatic hydrocephalus,PTH）患者侧脑室-腹腔（ventricle-peritoneal,V-P）分流术的疗效. 方法 对2004年1月-2007年6月经治的接受V-P分流术无典型症状的PTH患者进行回顾性分析.收集患者的一般资料、TBI、PTH和V-P分流术后的随访信息,分析患者预后改善率与相关因素. 结果 本组共31例患者,V-P分流术后共随访12个月,其中20例（65％）临床情况有明显改善.10例去骨瓣减压术后合并有PTH患者中,9例在V-P分流术后行颅骨修补术,临床情况明显改善.患者年龄、分流管置入前CT影像评估的PTH严重程度与V-P分流术的效果显著相关. 结论 多数无典型症状的PTH患者接受V-P分流术后临床预后改善,并且年轻患者及V-P分流术前PTH严重程度相对较轻的患者在分流术后预后更佳.

Objective To investigate the effect of ventricle-peritoneal （V-P） shunt in treatment of patients who developed post-traumatic hydrocephalus （PTH） with no symptoms or with atypical symptoms due to an excessively severe traumatic brain injury （TBI）.Methods A retrospective study was performed in patients who developed PTH with atypical symptoms undergone V-P shunt from January 2004 to June 2007.Patients＇ general information,TBI data,PTH severity and postoperative follow-up data were collected and applied to assay the improvement rate in prognosis and its associated factors.Results Thirty-one patients were involved in this study.After 12 months of follow-up,20 （65%） patients revealed significant improvements in clinical symptoms.Among 10 patients who developed PTH after decompressive craniectomy,cranioplasty was performed following V-P shunt and significant improvements were observed in nine patients.Patients＇ age and severity of PTH based on CT evaluation before shunt placement were strongly correlated with the surgical outcome.Conclusions Most PTH patients with atypical symptoms can benefit from V-P shunt.Additionally,younger patients and those with less severe PTH before V-P shunt are expected a better outcome.