B超引导下脑室-腹腔分流术治疗特发性颅高压疗效分析

Surgical treatment of ventriculoperitoneal shunt guided by ultrasound to the patients with idiopathic intracranial hypertension

目的探讨侧脑室-腹腔分流术治疗特发性颅高压（IIH）患者的临床疗效。方法对象为河南省人民医院2011年8月至2014年2月收治的IIH患者，共32例，年龄24～45（36．6）岁。32例中上矢状窦闭塞2例，横窦闭塞2例，4例均有慢性中耳炎病史；影像学无静脉窦异常28例，28例中口服避孕药物史2例，病因不详26例。32例均行侧脑室-腹腔分流术。结果32例术后头痛、恶心、呕吐等症状均明显缓解，除1例因术前双眼失明外，其余31例术后视力均有不同程度好转。2例失访，其余30例随访2年，围手术期感染0例，术后1年时感染1例，无分流管堵塞病例。结论IIH患者当药物治疗无效时应采取积极的外科治疗，侧脑室-腹腔分流术可取得满意的临床疗效，术中应用B超引导可精确穿刺侧脑室。

Objective To investigate the clinical efficacy of ventriculoperitoneal shunt treatment to patients with idiopathic intracranial hypertension. Methods The clinical data of 32 patients with idiopathic intracranial hypertension who were admitted to Henan Provincial People＇s Hospital from August 2011 to February 2014 were collected. The underlying diseases included occlusion of the superior sagittal sinus （2 cases） and occlusion of transverse sinus （2 cases） , and all 4 cases had a history of chronic otitis media. Twenty eight cases, with a history of oral contraceptive drugs （2 cases ） and unclear etiology （26 cases）, had normal venous sinus confirmed by imaging examination. All of 32 patients underwent ventriculoperitoneal shunt. Results The symptoms of 32 patients such as headache, nausea, and vomiting were relieved obviously after surgery. The symptom of visual impairment of 31 cases got better in varying degrees except that 1 case went blind before operation. Besides 2 cases of loss of follow-up, the remaining 30 cases were followed up for 2 years. Thirty cases had no perioperative infection. One case had infection 1 year after operation. No one had the shunt tube blockage. Conclusions Patients with idiopathic intracranial hypertension should be taken active surgical treatment when drug therapy fails and could obtain satisfactory clinical curative effect by accepting treatment of ventriculoperitoneal shunt. By intraoperative ultrasound guiding lateral ventricle puncture can be achieved accurately.