腰大池-腹腔分流术治疗正常压力脑积水的临床分析

Clinical analysis of lumboperitoneal shunts for the treatment of idiopathic normal pressure hydrocephalus

目的总结腰大池-腹腔分流（LPS）术治疗特发性正常压力脑积水（iNPH）的疗效及优点。方法回顾性分析采用可调压分流管行LPS术治疗33例特发性正常压力脑积水（iNPH）病人的临床资料,主要临床表现有步态障碍、认知障碍和尿失禁,并分别采用5 m折返行走试验、简易智能精神状态检查（MMSE）和问卷调查方法对其进行评估。脑脊液放液试验阳性者作为手术治疗的必备条件,Evan’s指数评估手术前后脑室系统变化。结果本组脑脊液放液试验24 h内5 m折返行走试验阳性21例,24~72 h内阳性12例。术后随访6~24个月,多数病人临床症状不同程度好转。术前平均MMSE评分（24.8±2.8）分,术后6个月（26.2±2.5）分,两者差异显著（P〈0.05）;平均Evan’s指数术前为0.39±0.04,术后6个月为0.38±0.04,两者无显著差异（P=0.3137）。本组无死亡、术后感染和分流管堵塞等并发症。结论 LPS是治疗iNPH的有效方法,具有创伤小、恢复快、并发症少等优点。

Objective To investigate the therapeutic effects and advantages of lumboperitoneal shunt（LPS） for the treatment of idiopathic normal pressure hydrocephalus（iNPH）. Methods Clinical data of 33 iNPH patients treated by LPS were analyzed retrospectively. The main clinical features included gait disturbance, cognitive impairment and urinary incontinence, which were evaluated by 5-m Up Go test, mini-mental state examination（MMSE） and questionnaire respectively. Positive cerebrospinal fluid（CSF） tap test was a prerequisite for surgical treatment. The changes of the ventricular system after surgery were assessed by Evan＇s index. Results After CSF tap test,positive results of 5-m Up Go test were observed within 24 h in 21 patients and within 24 to 72 h in 12. During a follow-up period of 6to 24 months after shunt, clinical systems improved in different degree in the most patients. The mean MMSE scores before and 6months after shunt were 24.8 ± 2.8 and 26.2 ± 2.5 respectively, and the difference was significant（P〈0.05）. And the mean Evan＇s index before and 6 months after shunt was 0.39 ± 0.04 and 0.38 ± 0.04 respectively, the difference was not significant（P = 0.3137）. There were no death and complications such as postoperative infection and clogging of the shunt tube in this group. Conclusion LPS is a safe and effective therapy for iNPH with the advantages of minimal invasiveness, rapid recovery and fewer complications.