第三脑室底造瘘术和脑室腹腔分流术治疗梗阻性脑积水疗效分析

Analysis of neuroendoscopic third ventriculostomy and conventional ventriculoperitoneal shunt in treating obstructive hydroceohalus

目的探讨神经内镜下第三脑室底造瘘术和传统脑室腹腔分流术治疗梗阻性脑积水的疗效优劣。方法梗阻性脑积水患者60例,随机进行神经内镜下第三脑室底造瘘术或脑室腹腔分流术,对两组患者术后主要并发症、治疗有效率及术后复发率进行对比,并对结果进行统计学分析。结果两组患者术后颅内感染、脑室内出血、气颅、硬膜下积液、慢性硬膜下血肿的发生率分别为0.0%和3.1%、7.1%和3.1%、3.6%和3.1%、0.0%和6.2%、0.0%和6.2%,两者比较无统计学差异。两组患者术后治疗有效率分别为89.3%和84.4%,两者比较无统计学差异。造瘘组患者术后复发率为3.6%,低于分流组的28.1%,两者比较有统计学意义。结论神经内镜下第三脑室底造瘘术治疗梗阻性脑积水术后主要并发症及治疗有效率和传统脑室腹腔分流术无明显差异,但复发率比脑室腹腔分流术低,值得临床推广应用。

Objective To investigate the advantages and disadvantages of neuroendoscopic third ventriculostomy（ ETV） and ventriculoperitoneal shunt（ VPS） in treating obstructive hydroceohalus by curative effect analysis. Methods The clinical data of 60 patients with obstructive hydroceohalus were analyzed retrospectively. The operation main complications,effective treatment rate and recurrence rate between two surgical treatments was compared by statistical analysis. Results The post-operative intracranial infection rate was 0. 0% vs 3. 1%,the intraventricular hemorrhage rate was 7. 1% vs 3.1%,the intracranial pneumatocele rate was 3. 6% vs 3. 1%,the subdural effusion rate was 0. 0% vs6. 2%,the chronic subdural hematoma rate was 0. 0% vs 6. 2%,the effective treatment rate was 89.3% vs 84. 4% three month after operation respectively in the ETV group and the VPS group. There was no significant difference between the two groups. The post-operative recurrence rate was 3. 6% vs28. 1% respectively in the ETV group and the VPS group. There was significant difference between the two groups. Conclusions ETV has less recurrence rate than the conventional VPS in treating obstructive hydrocephalus. The main complication rate and effective treatment rate between the two treatments are not different. It is worthy of clinical popularization and application that treating obstructive hydrocephalus by ETV.