神经内镜下第三脑室底造瘘术联合脑室-腹腔分流术治疗高血压脑出血术后慢性正常压力脑积水的效果分析

Analysis of the therapeutic effect of endoscopic third ventriculostomy combined with endoscopic assisted ventriculoperitoneal shunt in the treatment of chronic hydrocephalus with normal pressure after hypertensive intracerebral hemorrhage surgery

目的探讨神经内镜下第三脑室底造瘘术(ETV)联合神经内镜引导下脑室-腹腔分流术(VPS)治疗高血压脑出血术后慢性正常压力脑积水患者的临床效果。方法回顾性连续纳入2018年6月至2022年6月广州中医药大学顺德医院脑病科收治的高血压脑出血术后慢性正常压力脑积水患者42例,按照治疗方法不同分为内镜联合分流组和传统分流组,每组21例。内镜联合分流组采用ETV联合神经内镜引导下VPS治疗,传统分流组单纯应用VPS治疗。比较两组患者术后成功穿刺至预设位置、术后并发症(发热、颅腔积气、硬脑膜下积液、颅内出血、颅内感染、低颅压、癫痫)、术后分流管堵管、术后近期(术后≤3个月)疗效及远期(术后>3个月)疗效。结果内镜联合分流组成功穿刺至预设位置患者比例[95.2%(20/21)比71.4%(15/21);χ^(2)=4.286,P=0.038]、术后远期总临床有效率[85.7%(18/21)比57.1%(12/21);χ^(2)=4.200,P=0.040]均高于传统分流组,术后分流管堵管发生率低于传统分流组[4.8%(1/21)比28.6%(6/21);χ^(2)=4.286,P=0.038],术后发热[66.7%(14/21)比33.3%(7/21);χ^(2)=4.667,P=0.031]、颅腔积气[42.9%(9/21)比14.3%(3/21);χ^(2)=4.200,P=0.040]发生率均高于传统分流组,两组术后硬脑膜下积液、颅内出血、低颅压、颅内感染及癫痫等并发症发生率及近期总临床有效率差异均无统计学意义(均P>0.05)。结论ETV联合神经内镜引导下VPS治疗高血压脑出血术后正常压力脑积水总有效率高于单纯VPS,具有远期疗效好、穿刺至预设位置成功率高、术后堵管发生率低等优势。

Objective To explore the clinical efficacy of endoscopic third ventriculostomy(ETV)combined with endoscopic ventriculoperitoneal shunt(VPS)in the treatment of chronic hydrocephalus with normal pressure after hypertensive intracerebral hemorrhage surgery.Methods A retrospective study was conducted on 42 patients with postoperative chronic hydrocephalus with normal pressure after hypertensive intracerebral hemorrhage admitted to the Department of Cerebrology,Shunde Hospital,Guangzhou University of Chinese Medicine from June 2018 to June 2022.They were divided into endoscopic combined shunt group and traditional shunt group according to different treatment methods,with 21 patients in each group.The endoscopic combined shunt group used ETV combined with neuroendoscopic guided VPS treatment,while the traditional shunt group only used VPS treatment.Compare the success of postoperative puncture to the preset position,postoperative complications(fever,pneumocephalus,subdural effusion,intracranial hemorrhage,intracranial infection,low intracranial pressure,epilepsy),postoperative shunt blockage,short-term postoperative efficacy(within 3 months),and long-term therapeutic efficacy(after 3 months)between two groups.Results The proportion of patients in the endoscopic combined shunt group who successfully puncture to the preset position(95.2%[20/21]vs.71.4%[15/2];χ^(2)=4.286,P=0.038)and postoperative long-term total effective rate(85.7%[18/21]vs.57.1[12/21];χ^(2)=4.200,P=0.040)were all higher than those in the traditional shunt group,and the incidence of postoperative shunt tube blockage was lower than that in the traditional shunt group(4.8%[1/21]vs.28.6%[6/21];χ^(2)=4.286,P=0.038),the incidence of postoperative fever(66.7%[14/21]vs.33.3%[7/21];χ^(2)=4.667,P=0.031)and pneumocephalus(42.9%[9/21]vs.14.3%[3/21];χ^(2)=4.200,P=0.040)were higher than those of traditional shunt surgery.There was no statistically significant difference in the incidence of postoperative complications such as subdural effusion,intracranial hemorrhage,low intracranial pressure,intracranial infection,and epilepsy between two groups(all P>0.05).Conclusions The total effective rate of ETV combined with neuroendoscopic guided VPS in the treatment of postoperative hydrocephalus with normal pressure after hypertensive intracerebral hemorrhage is higher than that of VPS alone.It has advantages such as good long-term efficacy,high success rate of puncture to the preset position,and low incidence of postoperative blockage.