以脑积水分类为依据选择三脑室底造瘘术或脑室腹腔分流术临床效果观察(附105例报告)

Clinical Outcome of Classification Based Selection of Third Ventriculostomy or Ventriculoperitoneal Shunt Surgery for Hydrocephalus(Report of 105 Cases)

目的通过对比简列数据,探讨单纯依据脑积水分类选择治疗方式可行性,并验证此项临床治疗模式的有效性、安全性。方法回顾性分析2015年1月至2018年5月在解放军总医院第一医学中心诊治的脑积水手术患者资料。按人数均分为两组,依据梗阻性脑积水和交通性脑积水分类,分别采用内镜下三脑室底造瘘术(ETV)和脑室腹腔分流术(VPS),对两种术式治疗效果及并发症进行随访观察,将相关数据予以统计分析并做总结性报告。结果以脑积水分类为依据选择三脑室底造瘘术或脑室腹腔分流术临床效果显优且具有一定实施价值,其效果各项评分改善情况显著,共纳入105例,其中梗阻性脑积水45例,均行ETV,短期显效43例(95.56%),无效2例(4.44%),术后感染1例(2.22%);3个月随访显效42例(93.33%),无效3例(6.67%)。45例患者中,术后1、2周的总症状改善率相较于术前均明显降低存在统计学差异(P<0.05)。45例患者的人文关怀、指标管理及随访效果满意度为91.11%、88.89%、95.56%。交通性脑积水60例,均行VPS,短期显效57例(95%),无效3例(5%)。术后穿刺道少量出血3例(5%),感染2例(3.33%),经过内科保守治疗痊愈;脑室端堵管3例(5%),经过外科调整后通畅。3个月随访结果为显效60例(100%)。60例患者中,术后1、2周的总症状改善率相较于术前均明显降低存在统计学差异(P<0.05)。60例患者的人文关怀、指标管理及随访效果满意度为90.00%、93.33%、95.00%。结论梗阻性脑积水采用ETV,交通性脑积水采用VPS术式可获得较好临床效果,可减少并发症。在提升护理质量的基础上,以脑积水分类作为术式选择的主要依据,值得提倡推广。

Objective To explore the feasibility of selecting treatment methods only according to the classification of hydrocephalus,and to verify the effectiveness and safety of this nursing/clinical treatment mode.Methods The data of patients with hydrocephalus treated in the first medical center of PLA General Hospital from January 2015 to May 2018 were analyzed retrospectively.According to the classification of obstructive hydrocephalus and communicating hydrocephalus,endoscopic triple ventriculostomy(ETV)and ventriculoperitoneal shunt(VPS)were used respectively.The therapeutic effects and complications of the two methods were followed up,and the relevant data were statistically analyzed and summarized.Results According to the classification of hydrocephalus,the clinical effect of three ventriculostomy or ventriculoperitoneal shunt was excellent and had certain implementation value.The scores of its effect were significantly improved.One hundred and five cases were included,including 45 cases of obstructive hydrocephalus,all of which underwent ETV.Forty-three cases(95.56%)were significantly effective in short term,2 cases(4.44%)were ineffective,and 1 case(2.22%)was postoperative infection;After 3-month follow-up,42 cases(93.33%)were significantly effective and 3 cases(6.67%)were ineffective.Among the 45 patients,the improvement rate of total symptoms 1 and 2 weeks after surgery was significantly lower than that before surgery,with statistical difference(P<0.05).The satisfaction of humanistic care,index management and follow-up effect of 45 patients were 91.11%,88.89%,95.56%.60 cases of communicating hydrocephalus were treated with VPS.57 cases(95%)were significantly effective in the short term and 3 cases(5%)were ineffective.After operation,3 cases(5%)had a small amount of bleeding in the puncture tract,2 cases(3.33%)had infection,and 3 cases(5%)had ventricular end blockage,which was unobstructed after surgical adjustment.The results of 3-month follow-up showed that 60 cases(100%)were effective.Among the 60 patients,the improvement rate of total symptoms 1 and 2 weeks after surgery was significantly lower than that before surgery,with statistical difference(P<0.05).The satisfaction of humanistic care,index management and follow-up effect of 60 patients were 90.00%,93.33%and 95.00%.Conclusion ETV for obstructive hydrocephalus and VPS for communicating hydrocephalus can obtain better clinical effect and reduce complications.The classification of hydrocephalus can be used as the main basis for the selection of surgical methods.It is recommended to be widely used in clinic.