重型颅脑损伤术后早期脑积水的临床治疗研究

Clinical treatment of early hydrocephalus after severe brain injury

目的评价早期同期行脑室-腹腔分流加颅骨修补术治疗重型颅脑损伤术后颅骨缺损合并脑积水的疗效,并对其术后并发症进行分析。方法回顾性分析恩施州民族医院神经外科2011年7月~2013年10月手术治疗的重型颅脑损伤术后颅骨缺损合并脑积水患者的临床资料,其中24例（A组）予早期同期脑室-腹腔分流加颅骨修补术,15例（B组）予先行脑室-腹腔分流术,1~2周后再行颅骨修补术;比较两组患者的手术效果及并发症,术后随访6个月至2年。结果 A组24例中术后有效22例,有效率91.6%,分流感染1例,感染率4.1%;B组15例术后有效12例,有效率80%,分流感染4例,感染率26%。两组共39例患者中均无分流过度、颅内出血、脑脊液漏、切口感染、修补材料外露、硬膜下积液或血肿等并发症;35例获随访6个月至2年,无分流管阻塞、滑脱、无死亡病例。结论早期同期行脑室-腹腔分流加颅骨修补术较分次手术的疗效显著,并可降低分流感染的发生率,是重型颅脑损伤术后颅骨缺损合并脑积水患者有效的、经济实用的治疗手段。

Objective To evaluate of early period ventriculoperitoneal shunt plus cranioplasty in the treatment of severe traumatic brain injury after operation of skull defect associated with hydrocephalus and curative effect, and the postoperative complications were analyzed. Methods A retrospective analysis from July to 2011 in our department to 2013 October operation in treatment of severe traumatic brain injury after operation for skull defects and hydrocephalus in patients with clinical data, of which 24 cases （group A） to the early period of ventriculoperitoneal shunt plus cranioplasty, 15 cases （group B） to the first ventricle abdominal cavity shunt, 1-2 weeks after cranioplasty; comparing the two groups of patients with operation results and complications, postoperative follow up of 6 months to 2 years. Results Among the 24 patients in group A after operation in 22 cases, with an efficiency of 91.6%, shunt infection in 1 cases, the infection rate was 4.l%; in 15 cases in group B after operation in 12 cases, with an efficiency of 80%, shunt infection in 4 cases, the infection rate was 26%. Two groups of a total of 39 patients were no shunt excessive, intracranial hemorrhage, cerebrospinal fluid leak, infection of incision, repair materials exposed, subdural effusion or hematoma complication; 35 cases were followed up for 6months to 2 years, no shunt tube obstruction, slippage, no deaths. Conclusion The early stage of ventrieuloperitoneal shunt plus cranioplasty is divided operation curative effect, and may reduce the incidence of shunt infection, is after severe head injury in patients with skull defect with hydrocephalus effective, economical and practical treatment method.