摘要
目的探讨应用软性神经内镜治疗脑囊虫病的疗效。方法 2007年10月～2011年1月,应用软性神经内镜(主机为FUJINON EPX-2200电子视频内镜系统;镜体为FUJINON EB-270P超细软性内镜,外径3.8 mm,工作通道直径1.2mm,观察视野120°,工作长度365 mm)治疗脑囊虫病15例,其中7例为院外脑室-腹腔分流术后分流故障。术中经额部钻孔,内镜下先行透明隔及第三脑室底造瘘,导水管闭塞者加行导水管成形,对脑室及基底池全面探查,摘除所见囊虫囊泡,灌洗清洁脑室。结果 15例顺利完成手术,摘除脑室或基底池内所见囊虫囊泡,7例脑室-腹腔分流术后均成功摆脱了分流依赖。镜下手术时间15～40 min,(26±8)min。出血量15～50 ml,(27±6)ml。除2例术后出现高热延迟出院外,其余13例均于术后6 d出院。15例术后随访8～46个月,平均29.8月,术前症状缓解,无复发及其他不良反应,磁共振检查示脑积水缓解,导水管区、第四脑室正中孔及第三脑室底瘘口脑脊液流动良好。结论电子神经内镜下经单侧额部钻孔侧脑室入路可对整个脑室系统及基底池进行探查,寻找并摘除囊虫囊泡,手术操作简便,创伤小,恢复快。
Objective To investigate the therapeutic effect of flexible neuroendoscopic management for cerebral cysticercosis.Methods A total of 15 cases of cerebral cysticercosis,including 7 cases of shunt malfunction,were treated by flexible neuroendoscope（FUJINON EPX-2200 and FUJINON EB-270P,outer diameter 3.8 mm,operational channel 1.2 mm,observation field 120°,operational length 365 mm） through a frontal keyhole in our hospital from October 2007 to January 2011.Endoscopic septostomy and third ventriculostomy were carried out on the patients,and then followed by aqueductoplasty in those with occlusive aqueduct so that to make a thorough exploration and remove all the vesicae and cysticerci in the whole ventricular system and basal cisterna,and then to carry out ventricular irrigation to clean the ventricular system. Results The procedure was completed successfully in all the 15 cases.All the vesicae and cysticerci were removed,and the 7 patients who had shunt malfunction recovered as well.The mean neuroendoscopic operation time was（26±8） min（15-40 min）,and mean intraoperational blood loss was（27±6） ml（15-50 ml）.All the patients were discharged from hospital in 6 days after the operation,except for 2 cases who had longer postoperative stay because of high fever.Fifteen patients were followed up for 8-46 months with a mean of 29.8 months,and preoperative symptoms were relieved without recurrence or other side reactions;MRI showed that hydrocephalus was relieved in all the cases,and normal cerebrospinal fluid flow around the cerebral aqueduct,median aperture of the fourth ventricle,and puncture of the floor of the third ventricle.Conclusions With flexible neuroendoscopy via a unilateral frontal keyhole,we can explore the whole ventricular system and basal cisterna,so that to position and remove vesicae and cysticerci.The procedure is convenient and minimally invasive with quick recovery.
出处
《中国微创外科杂志》
CSCD
2012年第3期272-274,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
脑囊虫病
软性神经内镜
Cerebral cysticercosis Flexible neuroendoscopy
