脑室-腹腔分流术治疗继发性正常压力脑积水的临床分析

Clinical analysis of ventriculoperitoneal shunt for secondary normal pressure hydrocephalus

目的 探讨应用脑室-腹腔分流术治疗继发性正常压力脑积水的临床疗效及并发症。 方法 回顾性分析2012年1月至2016年11月解放军第一○一医院神经外科收治的202例继发性正常压力脑积水患者的临床资料,所有患者均行脑室-腹腔分流术治疗。总结手术效果和并发症,并采用Black分流预后评分评估患者的预后。 结果 脑室-腹腔分流术后的影像学结果提示脑室减小者185例(91.6%)。术后1周内7例(3.5%)出现并发症,其中2例(1.0%)发生穿刺道出血,2例(1.0%)发生颅内感染,3例(1.5%)发生分流不畅。随访时间为3~60个月,平均(11.2±12.6)个月。随访中出现癫痫23例(11.4%);分流相关并发症29例(14.4%),其中颅内感染3例(1.5%),孤立性第四脑室3例(1.5%),硬膜下积液16例(7.9%),堵管予再次分流7例(3.5%)。5例(2.5%)死于呼吸、循环系统并发症。79.7%(161/202)的患者分流效果良好 (Black治愈率≥30%)。单因素分析和多因素logistic回归分析显示,术前格拉斯哥昏迷评分较低(OR=0.600,95% CI:0.501~0.719,P<0.001)、意识改变不显著(OR=0.206,95% CI:0.086~0.495,P<0.001)、合并原发性高血压(OR=2.690,95% CI:1.134~6.378,P=0.025)患者的总体预后欠佳。 结论 采用脑室-腹腔分流术治疗继发性正常压力脑积水是一种安全、有效的方法,选择合适的病例进行干预,能够获得良好的预后。

Objective To explore the clinical outcome and complications of ventriculoperitoneal (VP) shunt for secondary normal pressure hydrocephalus.Methods The clinical data of 202 patients with secondary normal pressure hydrocephalus treated with VP shunt at Department of Neurosurgery, the No. 101 Hospital of PLA from January 2012 to November 2016 were retrospectively analyzed. The surgical effect and complications were summarized. The clinical outcome was analyzed using the Black Grading Scale.Results Among 202 patients, the ventricles of 185 (91.6%) cases were narrowed after VP shunt. One week post operation, poor outcomes were reported in 7(3.5%) cases, out of which 2 (1.0%) showed hemorrhage, 2 (1.0%) had intracranial infection and 3 (1.5%) had blocked splitter and underwent shunt again. The mean follow-up duration was 11.2±12.6 months and ranged from 3 to 60 months. During the follow-up, seizures occurred in 23 (11.4%) patients. There were 29 (14.4%) patients who developed shunt-related complications. Among them, 3 (1.5%) had the trapped fourth ventricle, 3 (1.5%) reported intracranial infection, 16 (7.9%) had subdural effusion, 7 (3.5%) had blocked splitter and underwent revision surgery. Five cases died of cardiorespiratory system disorder. Finally, 79.7% (161/202) patients achieved favorable clinical outcome (Black cure rate ≥30%). Multivariate logistic regression analysis showed that lower Glasgow Coma Scale (OR=0.600, 95%CI: 0.501-0.719, P<0.001), no obvious change of consciousness (OR=0.206, 95% CI: 0.086-0.495, P<0.001) and previous history of hypertension (OR=2.690, 95% CI: 1.134-6.378, P=0.025) were risk factors associated with poor outcome.Conclusions VP shunt is suggested to be a safe and efficacious way to treat secondary normal pressure hydrocephalus. Proper selection of surgical candidates could be helpful for favorable outcome.