不同手术径路脑室-腹腔分流术疗效比较

Effect Comparison of Ventriculoperitoneal Shunt with Different Surgical Approaches for Hydrocephalus

目的比较不同手术路径行脑室-腹腔分流术治疗脑积水的临床疗效。方法回顾性分析我科2018年3月至2021年3月收治的91例中重度脑积水患者的临床资料,依据手术路径的不同分为实验组(50例)和对照组(41例),分别采用经侧脑室枕角穿刺耳后路径腹腔分流术和传统经侧脑室额角穿刺耳后路径腹腔分流术进行治疗。比较两组临床疗效及术后并发症情况。结果术后实验组患者症状改善49例(98%),对照组症状改善36例(87.8%)。术后第10 d复查颅脑CT示脑室有不同程度的缩小。实验组术后脑室内导管位置满意率高于对照组,术后分流管堵塞率低于对照组,差异均有统计学意义(P<0.05),两组脑室缩小、症状改善、感染率及二次手术率比较,差异均无统计学意义(P>0.05)。结论采用经侧脑室枕角穿刺耳后路径腹腔分流手术治疗脑积水优势明显,效果较好,在临床治疗中建议优先选用。

Objective To compare the clinical effect of ventriculoperitoneal shunt in the treatment of hydrocephalus with different surgical approaches.Methods Retrospective analysis of the clinical data of 91 hydrocephalus patients admitted to our department from March 2018 to March 2021 was carried out.All cases were divided into the experiment group(n=50)and the control group(n=41),and performed ventriculoperitoneal shunt by posterior ear approach with occipital horn puncture and drainage catheter and traditional front horn puncture and drainage catheter respectively.The clinical effect and postoperative complications were compared between the two groups.Results The symptoms improved in 49 patients(98%)in the experimental group and 36 patients(87.8%)in the control group after the surgery.CT showed that the ventricles were shrunk in all cases on the 10th day after the operation.Compare to the control group,the satisfactory rate of intra-ventricular catheter position was higher,the blockage rate of shunt tube was lower in the experimental group after the operation,and all the differences were significant(P<0.05).There was no statistical difference in the rates of ventricular shrinkage,symptom improvement,infection and secondary operation between the two groups(P>0.05).Conclusion The method of ventriculoperitoneal shunt with occipital horn puncture by posterior ear approach can be preferred with obvious advantages and reliable effect for hydrocephalus.