腰大池腹腔分流手术治疗继发性交通性脑积水的研究

Study of lumbar-peritoneal shunt for secondary communicating hydrocephalus

目的探讨腰大池腹腔分流手术(L-P)和脑室腹腔分流手术(V-P)对于L-P分流治疗交通性脑积水的效果及安全性。方法采用可调压式腰大池腹腔分流管对27例交通性脑积水的患者进行手术治疗,同期应用传统的脑室腹腔分流手术及可调压脑室腹腔分流管对19例脑积水患者进行了手术治疗,对2组患者的年龄、性别、原发病组成、手术前后颅内压、并发症发生率、手术操作时间、手术中出血量、术后调压次数进行了比较,并对腰大池腹腔分流手术组患者手术前后颅内压进行比较。结果2组患者在年龄、性别、术前颅内压、术后颅内压、手术操作时间、原发病组成、术后感染发生率、术后堵管发生率上无差异;L-P组术后调压1次14人次、调压2次3人次、调压3次2人次;V-P组术后调压1次16人次、调压2次8人次、调压3次3人次,2组间术后调压次数无差异(P=0.374);L-P组和V-P组术中平均出血量分别为10 mL(四分位间距10)和30 mL(四分位间距10),L-P组术中出血量较少(P<0.001);L-P分流效果良好、术后颅内压水平明显下降(P<0.001)。结论颅脑损伤和脑出血等引起的继发性交通性脑积水采用腰大池腹腔分流术能有效解除颅高压,与传统脑室腹腔分流手术比较效果相似、并发症发生率相仿;但是L-P手术中出血量少,且手术操作更简便、创伤更小。

Objective To evaluate the efficacy and safety of L-P shunt in the treatment of secondary com⁃municating hydrocephalus by retrospectively comparing L-P shunt and V-P shunt from January 2018 to December 2021.Methods Totally 27 patients were treated with adjustable L-P shunt,and 19 patients were treated with tra⁃ditional adjustable V-P shunt.All patients were diagnosed as secondary communicating hydrocephalus.Age,sex,primary disease,intracranial pressure before and after operation,incidence of complications,operation time,The amount of blood loss during surgery,times of postoperative pressure adjustment were compared between the two groups,and intracranial pressure before and after L-P shunt was compared.Results There was no difference in age,sex,preoperative intracranial pressure,postoperative intracranial pressure,operation time,composition of primary disease,incidence of postoperative infection and postoperative tube occlusion between the two groups.There were 14 person-times of postoperative pressure regulation,3 times of pressure regulation and 2 times of pressure regulation in Lmurp group,while 16 person-times,8 times and 3 times of pressure regulation in Vmurp group.There was no significant difference in the number of postoperative pressure regulation between the two groups(P=0.374).The average intraoperative blood loss was 10 mL(10 quartile interval)and 30ml(10 quartile interval)in Lmurp group and Vmurp group,respectively,while the intraoperative blood loss in Lmurp group was less than that in Lmurp group(P<0.001),and the postoperative intracranial pressure decreased significantly in Lmurp group(P<0.001).Conclusion L-P shunt can effectively relieve intracranial hypertension in secondary communicating hydrocephalus caused by cerebral injury and intracerebral hemorrhage.It has similar effect and complication rate with traditional V-P shunt.L-P shunt,however,is relatively simple to operate and minimal invasive.