去骨瓣减压术后脑积水的治疗策略及疗效分析

Strategies of treatment and their efficacy analysis of hydrocephalus after decompressive craniectomy

目的通过对去骨瓣减压术(DC)后脑积水的治疗效果分析,探讨DC后脑积水的手术策略。方法回顾性分析山东省潍坊市益都中心医院2021年9月至2023年8月被诊断为DC后脑积水的51例患者临床资料及随访资料。按照治疗方式不同将其分为同期组(同时行脑室腹腔分流术与颅骨修补术,19例)与非同期组(32例),其中非同期组分为分流组(先行脑室腹腔分流术观察病情变化一段时间后再行颅骨修补术,20例)与修补组(包括先行颅骨修补术后脑室腹腔分流术10例与仅行颅骨修补术2例,12例)。比较不同治疗方案的效果及并发症发生率。结果同期组与非同期组的手术治疗有效率比较,差异无统计学意义(P>0.05)。同期组的术后并发症发生率高于非同期组,差异具有统计学意义(P<0.05)。分流组与修补组的手术治疗有效率及术后并发症发生率比较,差异无统计学意义(P>0.05)。结论针对脑积水患者,建议分期行颅骨修补术与脑室腹腔分流术,而二者术式的先后选择对手术疗效及并发症并无明显影响,但如果条件允许,建议可优先行颅骨修补术。

Objective Through the analysis of the therapeutic effect of hydrocephalus after decompressive craniectomy(DC),the surgical strategy of hydrocephalus after DC was discussed.Methods The clinical data and follow-up data of 51 patients with hydrocephalus after DC diagnosed in Yidu Central Hospital of Weifang,Shandong province from September 2021 to August 2023 were retrospectively analyzed.According to different treatment methods,the patients were divided into concurrent group(simultaneous ventriculoperitoneal shunt and cranioplasty,19 cases)and non-concurrent group(32 cases).Among them,the non-concurrent group was divided into shunt group(first ventriculoperitoneal shunt to observe the condition change for a period of time and then cranioplasty,20 cases)and repair group(including 10 cases of ventriculoperitoneal shunt after cranioplasty and 2 cases of cranioplasty only,12 cases).The effects of different treatment regimens and the incidence of complications were compared.Results There was no significant difference in the effective rate of surgical treatment between the concurrent group and the non-concurrent group(P>0.05).The incidence of postoperative complications in the concurrent group was higher than that in the non-concurrent group,and the difference was statistically significant(P<0.05).There was no significant difference in the effective rate of surgical treatment and the incidence of postoperative complications between the shunt group and the repair group(P>0.05).Conclusion For patients with hydrocephalus,it is recommended to perform cranioplasty and ventriculoperitoneal shunt in stages,and the choice of the two procedures has no significant effect on the surgical efficacy and complications.However,if conditions permit,it is recommended to give priority to cranioplasty.