不同手术方案在严重颅脑损伤术后颅骨缺损并脑积水患者中的应用对比

Comparison of Different Operation Schemes in Patients with Craniocerebral Defect and Hydrocephalus After Severe Craniocerebral Injury

目的:对比不同手术方案在严重颅脑损伤术后颅骨缺损并脑积水患者中的应用。方法:选择2018年6月-2020年1月河南科技大学临床医学院收治的89例严重颅脑损伤术后颅骨缺损并脑积水患者作为研究对象,按交替分组法分为同期组与分期组,同期组45例行脑室-腹腔分流术(VPS)结合早期修补术,分期组44例VPS后2~3个月行修补术。比较两组临床疗效、术后格拉斯哥预后及昏迷评分(GOS、GCS)、脑积水程度及术后并发症情况。结果:术后同期组总有效率(95.56%)高于分期组(75.00%)(P<0.05);术后1d同期组GOS评分、GCS评分高于分期组(P<0.05);术后1d两组脑积水程度均降低,同期组低于分期组(P<0.05);术后随访3个月,同期组并发症发生率(4.44%)低于分期组(20.45%)(P<0.05)。结论:与VPS术后2~3个月行修补术相比,VPS联合早期修补术治疗严重颅脑损伤术后颅骨缺损并脑积水效果更好,能有效改善患者预后及脑积水程度,减少术后并发症。

Objective: To compare the application of different operation schemes in patients with severe craniocerebral injury and hydrocephalus. Methods: 89 patients with craniocerebral defects and hydrocephalus from June, 2018 to January, 2020 after severe craniocerebral injury were selected as the study objects. They were divided into the same period group and the stage group according to the alternating grouping method. 45 patients in the same period group underwent ventriculoperitoneal shunt(VPS)combined with early repair. 44 patients in the stage group underwent repair 2-3 months after VPS. The clinical effect, Glasgow prognosis and coma score(GOS and GCS), hydrocephalus degree and postoperative complications were compared between the two groups. Results: The total effective rate(95.56%) was higher than that of the stage group(75.00%)(P<0.05). GOS and GCS scores 1d after operation were higher than the stage group (P<0.05). Hydrocephalus degrees of two groups after operation reduced, and that of the same period group was significantly lower than that of the stage group (P<0.05). 3 month-follow-up after operation, the complication rate (4.44%) in the same time group was significantly lower than that in the stage group (20.45%)(P<0.05). Conclusion:Compared with 2-3 months after VPS, VPS combined with early repair is more effective in the treatment of severe craniocerebral injury with hydrocephalus, which can effectively improve the prognosis and degree of hydrocephalus, and reduce postoperative complications.