颅骨修补联合同侧脑室分流术治疗颅骨缺损并脑积水35例

Cranioplasty combined with ipsilateral ventriculoperitoneal shunt for treatment of 35 cases of skull defect with hydrocephalus

目的探讨颅骨修补联合同侧脑室分流术治疗颅骨缺损并脑积水的临床效果及安全性。方法回顾性分析78例颅骨缺损合并脑积水患者的临床资料,均一期行颅骨修补术及脑室分流术治疗,其中颅骨修补联合同侧脑室分流术35例(同侧手术组),对侧术式43例(对侧手术组)。结果同侧手术组在手术切口长度[(28.97±4.55)cm]、手术时间[(139.00±42.27)min]和术中出血量[(174.57±79.35)ml]明显优于对侧手术组[分别为(37.15±5.83)cm、(214.07±34.35)min、(257.21±72.02)ml],差异具有统计学意义(t值分别为6.786、8.656、4.815,P均<0.001)。2组术后脑积水程度均较术前明显改善(P<0.001),但2组间脑积水程度差异无统计学意义(P>0.05)。术后出现感染、癫痫、硬膜下积液、钛板下积液、过度引流等并发症,2组间差异无统计学意义(P>0.05),而同侧手术组的颅内出血率(2.86%)明显低于对侧手术组(20.93%;χ^(2)=4.138,P=0.042)。2组术后GCS评分均较术前改善(P<0.05),术后GCS评分比较差异无统计学意义(P>0.05)。术后6个月时,2组GOS有效率差异无统计学意义(χ^(2)=0.005,P=0.944)。结论颅骨修补联合同侧脑室腹腔分流术与对侧术式的治疗效果一致,但具有手术时间短、术中创伤小、出血少、颅内出血风险小等优点,适合临床推广和应用。

Objective To assess the clinical efficacy and safety of cranioplasty combined with ipsilateral ventricular shunt in the treatment of skull defect with hydrocephalus.Methods The clinical data of 78 patients with skull defect and hydrocephalus were analyzed retrospectively.All patients were treated by cranioplasty and ventriculoperitonea shunt in one stage,including 35 cases of cranioplasty combined with ipsilateral ventriculoperitonea shunt and 43 cases of contralateral operation.Results The incision length[(28.97±4.55)cm],operation time[(139.00±42.27)min],and intraoperative hemorrhage[(174.57±79.35)ml]in the ipsilateral operation group were significantly better than those in the contralateral operation group[(37.15±5.83)cm,(214.07±34.35)min,and(257.21±72.02)ml,respectively](t=6.786,8.656 and 4.815,respectively;P<0.001).The degree of postoperative hydrocephalus in the two groups was significantly improved(P<0.001),but there was no significant difference between the two groups(P>0.05).Among the postoperative complications,there was no significant difference in infection,epilepsy,subdural effusion,titanium plate effusion,or excessive cerebrospinal fluid drainage between the two groups(P>0.05).The incidence of intracranial hemorrhage in the ipsilateral operation group(2.86%)was significantly lower than that in the contralateral operation group(20.93%;χ^(2)=4.138,P=0.042).The postoperative Glasgow coma scale(GCS)scores of the two groups were improved compared with those before surgery(P<0.05),but there was no significant difference in the postoperative GCS scores between the two groups(P>0.05).At 6 months after surgery,there was no statistically significant difference in Glasgow outcome scale score between the two groups(χ^(2)=0.005,P=0.944).Conclusion Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as contralateral operation,but it has the advantages of shorter operation time,less trauma,less bleeding,and less risk of intracranial hemorrhage.