摘要
目的探讨分期和同期分流+颅骨修补方案对颅脑损伤减压术后交通性脑积水病人疗效及安全性的影响。方法研究对象选取重庆市开州区人民医院2015年6月至2017年3月收治颅脑损伤减压术后交通性脑积水病人共104例,其中A组(52例)采用分期分流联合颅骨修补方案治疗,B组(52例)采用同期分流联合颅骨修补方案治疗,比较两组近期疗效,手术前后格拉斯哥昏迷评分(GCS评分)、格拉斯哥预后评分(GOS评分)及术后并发症发生率。结果B组近期治疗总有效率(90.38%)显著高于A组(71.15%)(P<0.05);B组术后6个月GCS评分(12.89±1.78)分和GOS评分(4.30±0.95)分均显著优于A组[(10.02±1.56)分,(3.57±0.70)分]、术前[(7.19±1.33)分,(2.15±0.50)分](P<0.05);同时B组术后并发症发生率(5.77%)显著高于A组(19.23%)(P<0.05);下腔⁃腹腔分流术(VPS)术和腰蛛网膜下腔⁃腹腔分流术(LPS)治疗颅脑损伤减压术后交通性脑积水疗效比较差异无统计学意义(P>0.05);但LPS术术后并发症发生率(7.32%)显著低于VPS术(15.87%)(P<0.05)。结论颅脑损伤减压术后交通性脑积水病人行同期分流联合颅骨修补方案可显著缓解相关临床症状,促进颅内压水平降低和脑室缩小,降低伤残等级;但分期手术则有助于预防术后并发症发生;同时采用LPS术更有助于提高手术安全性。
Objective To investigate the influence of simultaneous operation and staging operation for shunt plus cranioplasty on the clinical efficacy and safety of patients with communicating hydrocephalus after craniocerebral injury decompression.Methods 104 patients with communicating hydrocephalus after craniocerebral injury decompression were chosen in People’s Hospital of Kai⁃zhou District from June 2015 to March 2017 and divided into 2 groups including A group(52 patients)with simultaneous opera⁃tion for shunt plus cranioplasty and B group(52 patients)with staging operation for shunt plus cranioplasty.The clinical effects for short⁃term,GCS score and GOS score before and after operation and postoperative complications incidence of both groups were com⁃pared.Results The clinical effects for short⁃term(90.38%)of B group were significant higher than A group(71.15%)(P<0.05).The GCS score[(12.89±1.78)points]and GOS score[(4.30±0.95)points]after operation of B group were significant lower than be⁃fore operation[(7.19±1.33)points,(2.15±0.50)points]and A group[(10.02±1.56)points,(3.57±0.70)points](P<0.05).The post⁃operative complications incidence(5.77%)of B group were significant higher than A group(19.23%)(P<0.05).There was no sig⁃nificant difference in the clinical effects between VPS operation and LPS operation(P>0.05).The postoperative complications inci⁃dence(7.32%)of LPS operation were significant lower than VPS operation(15.87%)(P<0.05).Conclusions Simultaneous opera⁃tion for shunt plus cranioplasty in the treatment of patients with communicating hydrocephalus after craniocerebral injury decom⁃pression can efficiently alleviate related clinical symptoms,promote intracranial pressure reduction and ventricular contraction and reduce the disability degree,while staging operation for shunt plus cranioplasty application could be helpful to prevent the postoper⁃ative complications.LPS application possess could elevate operation safety.
作者
蒋铭
张志国
李博
李军
JIANG Ming;ZHANG Zhiguo;LI Bo;LI Jun(Department of Neurosurgery,People’s Hospital of Kaizhou District,Kaizhou,Chongqing 405400,China)
出处
《安徽医药》
CAS
2020年第1期58-61,共4页
Anhui Medical and Pharmaceutical Journal
关键词
脑积水
颅脑损伤
减压颅骨切除术/副作用
脑室腹膜分流术
治疗结果
分期手术
同期手术
Hydrocephalus
Craniocerebral trauma
Decompressive craniectomy/adverse effects
Ventriculoperitoneal shunt
Treatment outcome
Staging operation
Simultaneous operation