脑室腹腔分流术治疗新型隐球菌脑炎合并颅高压的价值探讨

Value of ventricular peritoneal shunt in treating patients with intracranial hypertension combined wig cryptococcal meningitis

目的探讨脑室腹腔分流术（vPs）在新型隐球菌脑炎合并颅高压患者治疗中的可行性及安全性。方法收集中山大学附属第三医院神经外科自2012年1月至2014年1月行VPS治疗的12例新型隐球菌脑炎合并颅高压患者资料，对手术前后患者的临床表现、脑脊液实验室检查结果、甘露醇用量等情况进行对比，全部患者随访2-25个月。结果除1例患者术后神志无改善自动出院外，余11例患者头痛均消失或减轻，呕吐症状均消失，视力、听力下降者均得到明显改善，2例意识障碍者术后神志均好转，1例双眼外展受限者术后恢复正常，1例伸舌左偏、口角右歪者术后未改善。10例患者术后不同程度发热，9例经治疗后均恢复正常，1例术后持续低热，1月后拔除分流管时体温恢复正常。所有患者的脱水药物用量大幅减少或停用。11例患者术后脑脊液压力、隐球菌数量较术前有明显下降，而脑脊液白细胞、蛋白、糖含量术后没有明显变化。11例患者均康复出院，其中9例随访时完全恢复正常生活、工作，2例日常生活需要照顾。结论早期积极的VPS治疗对新型隐球菌脑炎合并颅高压患者是安全而有效的。

Objective To explore the feasibility and safety of ventricular peritoneal shunt （VPS） in treating patients with intracranial hypertension combined with cryptococcal meningitis. Methods Twelve patients with cryptococcal meningitis, admitted to our hospital from January 2012 to January 2014 and underwent VPS for intracranial hypertension, were chosen in our study; the clinical manifestations and cerebrospinal fluid （CSF） results before and after operation, and mannitol dosage before and after operation were compared; follow up for 2-25 months was performed. Results Except 1 patient had no improvement of consciousness, the other 11 patients had disappeared or mitigated headache, disappeared vomiting symptoms, and improved vision and hearing; two patients with disturbance of consciousness got improvement; one patient with eyes abduction got recovery; one patient had abnormal tongue and mouth did not achieve improvement. Different degrees of fever were noted in 10 patients after operation, 9 recovered after treatment. The maunitol dosage for all patients were significantly reduced or discontinued. Postoperative cerebrospinal fluid pressure, amount of cryptococcus neoformans in 11 patients were decreased significantly （P〈0.05）. Conclusion Early aggressive VPS on cryptococcal meningitis patients with intracranial hypertension is effective and safe.