两种不同术式治疗梗阻性脑积水的短期疗效及对患者并发症、复发率和远期预后的影响

Short-term efficacy of two different surgical methods in the treatment of obstructive hydrocephalus and its influence on complications,recurrence rate,and long-term prognosis

目的 探讨神经内镜三脑室底造瘘术(ETV)与脑室腹腔分流术(VPS)两种术式治疗梗阻性脑积水(OH)的短期疗效及对患者并发症、复发率和远期预后的影响。方法 回顾性分析2014年12月至2015年12月于铜川市人民医院神经外科住院的95例OH患者的临床诊治资料,其中51例行ETV纳入ETV组,44例行VPS纳入VPS组,术后随访5年,比较两组患者的手术时间、住院时间、住院费用、术后并发症、复发率、短期疗效(6个月)及远期疗效。结果 ETV组患者的手术时间、住院时间及住院费用分别为(86.85±20.53) min、(13.99±3.32) d、(29 026.18±9 569.64)元,明显短(低)于VPS组的(104.56±24.68) min、(17.69±4.28) d、(45 854.75±12 386.79)元,差异均有统计学意义(P<0.05);ETV组和VPS组患者的短期有效率分别为94.12%、90.91%,差异无统计学意义(P>0.05);ETV组患者的远期有效率为90.20%,明显高于VPS组的72.73%,差异有统计学意义(P<0.05);ETV组患者术后总并发症率、复发率分别为13.72%、1.96%,明显低于VPS组的31.82%、18.18%,差异均有统计学意义(P<0.05)。结论 ETV治疗OH的短期疗效与VPS相当,但其远期疗效更优,且能降低术后并发症和复发率,有望替代VPS作为治疗OH的首选术式。

Objective To explore the short-term efficacy of two different surgical methods,neuroendoscopic third ventriculostomy(ETV)and ventriculo-peritoneal shunt(VPS),in the treatment of obstructive hydrocephalus(OH)and its influence on complications,recurrence rate,and long-term prognosis.Methods The clinical diagnosis and treatment data of 95 patients with OH admitted to Department of Neurosurgery,People's Hospital of Tongchuan were retrospectively analyzed between December 2014 and December 2015.Among the patients,51 patients with ETV were included in ETV group,and 44 patients with VPS were enrolled as VPS group.The surgical time,length of hospital stay,hospitalization cost,postoperative complications,recurrence rate,short-term efficacy(6 months),and long-term efficacy were compared between the two groups.Results The surgical time,length of hospital stay,and hospitalization cost in ETV group were significantly shorter or less than those in VPS group:(86.85±20.53)min vs(104.56±24.68)min,(13.99±3.32)d vs(17.69±4.28)d,(29026.18±9569.64)yuan vs(45854.75±12386.79)yuan,P<0.05.There was no statistically significant difference in the short-term effective rate between ETV group and VPS group(94.12%vs 90.91%,P>0.05).The long-term effective rate in ETV group was 90.20%,significantly higher than 72.73%in VPS group(P<0.05).The total postoperative complication rate and recurrence rate in ETV group were significantly lower than those in VPS group(13.72%vs 31.82%,1.96%vs 18.18%,P<0.05).Conclusion The short-term efficacy of ETV is comparable to that of VPS in the treatment of OH,but ETV has better long-term efficacy,and can reduce postoperative complications and recurrence rate,which is expected to replace VPS as the first choice for the treatment of OH.