特发性正常压力型脑积水患者行手术和保守治疗的预后对比

Progression of Neuroimaging in Normal Pressure Hydrocephalus

目的对比行脑室-腹腔分流术(VPS)与保守治疗特发性正常压力型脑积水(i NPH)患者的预后,探索影响预后的可能因素。方法队列纳入109例i NPH患者,其中67例(61.5%)行VPS(VPS组),42例(38.5%)未行任何手术(保守治疗组)。VPS后1年,61.2%患者症状改善,其中步态障碍改善58.2%(39/67例),认知功能障碍改善50.8%(30/59例),尿失禁改善56.1%(23/41例)。VPS组和保守治疗组的5年整体生存率分别为(76.5±6.0)%和(68.0±9.1)%(P=0.313)。8/67例(11.9%)术后发生并发症,包括硬膜下积液4/67例(6.0%),血肿2/67例(3.0%),远端导管感染1/67例(1.5%),头痛1/67例(1.5%)。结论 VPS可以改善i NPH临床症状,至少术后5年内各项症状可以得到不断的改善,步态障碍的改善可能会好于认知功能障碍和尿失禁,但同时具有一定的术后并发症风险。

Aim To compare the outcomes of shunted and unshunted idiopathic normal pressure hydrocephalus （iNPH） patients and explore prognostic parameters. Methods A 5-year follow-up in a series of 109 cases. Results Among this cohort of 109 iNPH patients, 67（61.5%） were shunted and 42（38.5%） were not. One year after shunt, 61.2% of the patients showed clinical improvement, gait disturbance in 58.2%, cognitive impairment in 50.8% and urinary incontinence in 56.1% patients. Overall 5-year survival was （76.5＋6.0）% and （68.0＋9.1）% in the surgical and conservative group, respectively （P=0.313）. Post-surgical complications were found in 8 （11.9%） shunted patients. Conclusion VPS do render clinical improvement to iNPH patients, and in the same time, risk of complications. All components of Hakim Triad improve sustainably within at least 5 years after VPS.