摘要
目的探讨颅脑损伤合并脑积水采取减压修复与腹腔分流不同方案对治疗效果的影响。方法回顾性分析2015-2018年于该院行去骨瓣减压术并于术后并发脑积水的98例患者临床资料,均给予颅骨修补及脑室-腹腔分流处理,其中53例行分期手术(分期组),45例行同期手术(同期组),按手术顺序将分期组又分为先分流组(一期分流,二期修补,23例)和后分流组(一期修补,二期分流,30例),比较各组手术前后颅内压变化,术后脑脊液蛋白、白细胞计数及氯化物水平,治疗有效率及手术并发症发生情况。结果同期组治疗有效率(93.3%)高于先分流组(78.3%)和后分流组(73.3%),差异有统计学意义(P<0.05)。同期组术后颅内压低于先分流组和后分流组,颅内压改善值(术前-术后)高于先分流组和后分流组,术后1周颅内压恢复正常者所占比例高于先分流组和后分流组,颅内压恢复正常时间短于先分流组和后分流组,差异均有统计学意义(P<0.05)。术后1周各组脑脊液蛋白、白细胞计数、氯化物水平接近,差异无统计学意义(P>0.05)。同期组并发症发生率(48.9%)低于先分流组(69.6%)和后分流组(63.3%),差异有统计学意义(P<0.05)。结论同期颅骨修补及脑室-腹腔分流术治疗颅脑损伤后交通性脑积水的效果优于分期处理,主要体现在降颅内压效率高和手术并发症少。分期处理中分流与修补两种手术的操作顺序对疗效和安全性的影响不大。
Objective To explore the effect of different regimens of decompression and abdominal shunt on craniocerebral injury combined with hydrocephalus.Methods The clinical data of 98 patients who underwent decompressive craniectomy and hydrocephalus in Center Hospital of Panjin City from 2015 to 2018 were retrospectively analyzed.All patients were treated with cranioplasty and ventriculo-peritoneal shunt,including 53 cases accepted staged surgery,45 cases accepted concurrent surgery according to the surgical sequence,the staged surgery group was divided into the first shunt group(phaseⅠshunt,phaseⅡrepair,23 cases)and the post-distribution group(phaseⅠrepair,phaseⅡshunt,30 cases),compared the changes in intracranial pressure before and after surgery,including postoperative cerebrospinal fluid protein,white blood cells count and chloride levels,treatment efficiency and surgical complications.Results The effective rate in the concurrent surgery group(93.3%)was higher than that in the first shunt group(78.3%)and the post-distribution group(73.3%),the differences were statistically significant(P<0.05).Intracranial pressure in concurrent surgery group was significant lower than those in the first shunt group and post-distribution group,the improvement of intracranial pressure(preoperative-postoperative),the proportion of patients with normal intracranial pressure returned to normal one week after surgery were higher than those of the first shunt group and post-distribution group,the normal time of intracranial pressure recovery in concurrent surgery group was shorter than that of the first shunt group and the post-distribution group,the differences were statistically significant(P<0.05).Cerebrospinal fluid protein,white blood cells count and chloride in each group 1 week after surgery were similar,and the differences were not statistically significant(P>0.05).The incidence of complications in the concurrent surgery(48.9%)was lower than that in the first shunt group(69.6%)and the post-distribution group(63.3%),the diff
作者
王洋
WANG Yang(Department of Neurosurgery,Center Hospital of Panjin City,Panjin,Liaoning 124010,China)
出处
《检验医学与临床》
CAS
2020年第1期58-61,共4页
Laboratory Medicine and Clinic
关键词
颅脑损伤
脑积水
颅骨修复术
脑室-腹腔分流术
craniocerebral injury
hydrocephalus
skull repair
ventriculo-peritoneal shunt
