脑室-腹腔分流术与颅骨修补术手术时机对去骨瓣减压术后并发症的影响

Effect of timing of ventriculo-peritoneal shunt and cranioplasty on postoperative complications after decompression of bone flap

目的 评估不同时机行脑室-腹腔分流术（V-P分流术）与颅骨修补术对去骨瓣减压术后并发症的影响.方法 收集并评估86例行分期或同期V-P分流术与颅骨修补术的去骨瓣减压术患者的临床资料.分析比较同期手术组与分期手术组的术后并发症发生率,采用二分类多因素Logistic回归分析评估术后并发症的相关因素.结果 颅脑损伤（39/86,45.3％）与自发性脑出血（33/86,38.4％）是造成颅骨缺损后脑积水最常见的原发病,切口延迟愈合或感染是最常见的并发症（13/86,15.1％）.同期手术组并发症发生率（55.2％）及术后感染发生率（28.9％）均高于分期手术组（18.8％、4.2％,P均＜0.01）.多因素Logistic回归分析显示,手术时机（OR=1.616,95％ CI：1.026～2.593,P=0.042）及皮瓣紧张程度（OR =2.164,95％ CI：1.056 ～4.462,P=0.038）与患者术后并发症显著相关.结论 分期行V-P分流术与颅骨修补术,可减少去骨瓣减压术后合并脑积水患者的术后并发症,术前皮瓣膨隆明显者更应采用分期手术.

Objective To evaluate the effects of ventriculo-peritoneal （V-P） shunt and craniotomy of different timings on postoperative complications after decompression of bone flap.Methods The clinical data of 86 patients with bone flap decompression by V-P shunt and cranioplasty separately or simultaneously were collected and evaluated.The incidences of postoperative complications between simultaneous operation group and separate operation group were analyzed and compared.Binary multivariate Logistic regression analysis was used to assess the relative factors of postoperative complications.Results Craniocerebral injury （39/86,45.3%） and spontaneous intracerebral hemorrhage （33/86,38.4%） were the most common primary disease of hydrocephalus after skull defect,delayed healing or infection of the incision were the most common complications （13/86,15.1%）.The complication rate of patients in simultaneous operation group （55.2%） was significantly higher than that in separate operation group （18.8%,P 〈 0.01）,the incidence of postoperative infection in simultaneous operation group （28.9%） was significantly higher than that in separate operation group （4.2%,P =0.001）.Multivariate Logistic regression analysis showed that operation time （OR =1.616,95% CI：1.026-2.593,P =0.042） and flap tension （OR =2.164,95 % CI：1.056-4.462,P =0.038） were significantly associated with the postoperative complications.Conclusions V-P shunt and cranioplasty can reduce postoperative complications in patients with hydrocephalus after decompression of bone flap.The separate operation is suitable for the patients with obvious swelling of the skin flap before operation.