不同分流方式治疗创伤后脑积水的疗效及并发症分析

Curative effect and complication analysis of different shunt procedures for treatment of posttraumatic hydrocephalus

目的比较腰大池-腹腔分流术（LP）与脑室-腹腔分流术（VP）治疗创伤后脑积水（胛H）的疗效及并发症发生情况。方法回顾性分析2013年6月-2015年6月收治的PTH患者150例。65例行LP治疗（LP组），其中男36例，女29例；年龄（47．2±8．2）岁。85例行VP治疗（VP组），其中男53例，女32例；年龄（44．6±7．3）岁。比较两组患者有效率和并发症发生情况。结果所有患者均随访3～27个月。LP、VP组总有效率（显效＋有效）分别为97％和94％（P〉0．05）。术后并发症包括出血、感染、分流管堵塞与外露、分流过度与分流不足等。随访期间，VP组出现硬膜下血肿3例，颅内感染4例，分流管堵塞2例，过度分流3例及分流不足1例；LP组出现硬膜下血肿1例，颅内感染1例，分流泵外露1例，过度分流1例。两组患者经压力调整或者拔管后重新置管均恢复良好。LP组并发症发生率为6％，VP组为15％（P〈0．05）。LP组分流管拔除率及重新置管率均为2％，VP组分别为7％和8％（P〈0．01）。结论LP与VP治疗PTH疗效均良好，但LP的并发症发生率下降，分流管拔除率及重新置管率更低，值得临床推广应用。

Objective To compare the effect and complications of lumboperitoneal shunt （LP） and ventriculoperitoneal shunt （VP） in treatment of posttraumatie hydrocephalus （PTH）. Methods A retrospective study was made on 150 cases of posttraumatie communicating hydrocephalus managed with LP or VP from June 2013 to June 2015. There were 65 cases [36 males, 29 females; （47.2 -＋8.2） years of age] in LP group and 85 cases [ 53 males, 32 females ; （ 44. 6 -＋ 7.3 ） years of age ] in VP group. Therapeutic effect and complications were analyzed postoperatively. Results Period of follow-up was 3-27 months, which shoued Total effective rate of 97% in LP group and 94% in VP group （P 〉 0.05）. Postoperative complications were mainly hematoma, infection, shunt obstruction, shunt exposure, excessive shunt and inadequate shunt. At the follow-up, there were 3 subdural hematoma, 4 intracranial infection, 2 shunt obstruction, 3 excessive shunt and 1 inadequate shunt in VP group, but 1 subdural hematoma, 1 intracranial infection, 1 shunt exposure and 1 excessive shunt in LP group. Good results were achieved in the two groups after regulation of the shunt pressure or reoperation. In comparison, incidence of complications was 6% in LP group versus 15% in VP group （P 〈 0. 05）. Rate of shunt removal and reoperation in LP group were both 2% , but were 7% and 8% respectively in VP group （P 〈 0.01 ）. Conclusions Both shunt procedures are effective for posttraumatic hydrocephalus, while LP is a better choice in clinical application for the lower complication incidence, shunt removal rate and reoperation rate.