腹腔镜辅助脑室-腹腔分流术治疗老年特发性正常压力脑积水的临床疗效

The efficacy of laparoscope-assisted ventriculoperitoneal shunt in treatment of idiopathic normal pressure hydrocephalus in elder patients

目的 探讨腹腔镜辅助脑室-腹腔(V-P)分流术治疗老年特发性正常压力脑积水(iNPH)患者的临床疗效。 方法 回顾性纳入2015年1月至2018年1月苏州大学附属第一医院神经外科收治的78例老年(60~89岁)脑积水患者。其中采用传统V-P分流术治疗39例(简称常规组),采用腹腔镜辅助V-P分流术治疗39例(简称研究组)。比较两组患者治疗的有效率、治疗前后的日常生活能力(ADL)评分、手术前后iNPH的分级情况、Evans指数、胼胝体角值的变化和术后并发症的发生率。 结果 研究组患者的平均住院时间、下床活动时间及手术时间[分别为(10.5±2.3)d、(3.2±1.3)d、(63.2±10.5)min]与常规组 [分别为(19.8±3.6)d、(6.1±2.1)d 、(82.4±11.4)min]比较差异均有统计学意义(均P<0.05)。术后3个月和术后6个月,研究组的ADL评分[分别为(67.7±1.9)分、(89.6±2.5)分]明显高于常规组[分别为(52.0±1.3)分、(63.3±2.0)分](均P<0.05)。术后6个月研究组的iNPH分级评分[(3.8± 2.5)分]低于常规组[(6.8±2.8)分](P<0.05)。两组术后3个月和6个月的Evans指数及胼胝体角值较术前明显改善,但术后两组间的差异无统计学意义(均P>0.05)。研究组患者的总体并发症发生率[33.3%(13/39)]低于常规组[89.7%(35/39)],两组比较差异有统计学意义(P<0.001)。研究组患者的总有效率(89.7%)明显高于常规组(69.2%)(P<0.05)。 结论 与传统V-P分流术比较,腹腔镜辅助V-P分流术治疗老年iNPH的疗效更佳,精确定位导管的位置可有效减少总体并发症的发生,在一定程度上改善老年患者的临床症状及预后。

Objective To investigate the clinical efficacy of laparoscope-assisted ventricu-loperitoneal(VP) shunt in treatment of idiopathic normal pressure hydrocephalus (iNPH) in elder patients.Methods From January 2015 to January 2018, a total of 78 elder patients(60 to 89 years old) with iNPH were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University. Those patients were retrospectively analyzed and divided into 2 groups with 39 cases in each group: traditional surgical group (control group) and laparoscope-assisted operation group (treatment group). Traditional VP shunt was conducted in the control group and laparoscope-assisted VP shunt in treatment group. We compared the effectiveness in the 2 groups, pre- and postoperative activity of daily living (ADL) scores, classifications of iNPH, Evan's indexes as well as Callosal angles, incidences of postoperative complications.Results There were statistically significant differences in average hospitalization time, time of ambulation, average operating hours between the treatment group [(10.5±2.3) d, (3.2±1.3) d, (63.2±10.5) min, respectively] and the control group [(19.8±3.6) d, (6.1±2.1) d, (82.4±11.4) min, respectively] (all P<0.05). ADL scores in treatment group after 3 months and 6 months postoperatively (67.7±1.9, 89.6±2.5, respectively) were significantly higher than those in control group (52.0±1.3, 63.3±2.0, respectively), the classification score of iNPH in the postoperation treatment group (3.8±2.5) was lower than that in control group (6.8±2.8). Patients in the 2 groups were followed up for 3 months and 6 months post surgery. Evan's indexes and Callosal angle values were significantly improved compared with those before surgery. However, there was no statistically significant difference between the 2 groups (P>0.05). The incidence of shunt obstruction, postoperative infection rate, gastrointestinal symptoms, intracranial hypopressure syndrome, abdominal organ injury and cerebral hemorrhage in the treatment group were significantly lower than those in the control group, though these was no statistically significant differences between 2 groups (all P>0.05). The incidence of overall complications was lower in treatment group (33.3%, 13/39) than in control group (89.7%, 35/39) (P<0.001). The total effective rate of treatment group patients (89.7%) was significantly higher than that in control group (69.2%) (P<0.05).Conclusion Compared with the traditional VP shunt, laparoscope-assisted VP Shunt used for treatment of iNPH of elderly patients has significant curative effect, and the location of the catheter is accurate which could effectively prevent the total occurrence of postoperative complications and improve the clinical symptoms and outcome of elderly patients to certain degrees.