摘要
目的评估Fisher分级下终板造瘘联合腰大池引流对颅内动脉瘤夹闭术后慢性脑积水及预后的影响。方法将205例动脉瘤性蛛网膜下腔出血(aSAH)患者分为3组:A组为22例行单纯动脉瘤夹闭者;B组为104例开颅夹闭术中行终板造瘘者;C组为79例开颅夹闭术中行终板造瘘联合术后应用腰大池置管引流者。基于Fisher分级比较3组患者术后6个月慢性脑积水的发生率;术后对3组患者连续随访12个月,采用Kaplan-Meier生存分析法绘制生存曲线,使用Log-rank法进行单因素生存分析;采用改良Rankin量表评分(mRS)评价患者的预后。结果FisherⅠ~Ⅱ级:A组、B组及C组慢性脑积水的发生率分别为33.33%、13.16%、8.07%,差异无统计学意义(P>0.05);FisherⅢ级:A组、B组及C组慢性脑积水的发生率分别为38.46%、31.11%、8.82%,差异有统计学意义(P<0.05);FisherⅣ级:3组患者慢性脑积水的发生率差异有统计学意义(P<0.05,其中A组为33.33%,B组为38.10%,C组为9.09%),进一步采用Bonferroni法校正检验水平,其中B、C组差异有统计学意义(χ~2=8.679、P=0.003)。3组患者术后生存分析差异有统计学意义(P<0.001);随访结束时aASH术后mRS评分显示,仅在A组和B组、A组和C组间差异有统计学意义(P<0.05)。结论终板造瘘联合腰大池置管引流不仅可以降低FisherⅢ~Ⅳ级aSAH患者慢性脑积水的发生率,而且可以改善aASH患者预后,值得在临床中推广应用。
Objective to evaluate the effect of Fisher grading endplate fistulation combined with lumbar cistern drainage on chronic hydrocephalus after aneurysm clipping.Methods According to the difference of opera⁃tion methods,205 patients with aSAH were divided into three groups:group A:22 patients with simple action aneurysm clipping;group B:104 patients with endplate fistula during the operation of craniotomy clipping;group C:79 patients with endplate fistula during the operation of craniotomy clipping,combined with lumbar cistern drainage after the operation.Six months after SAH,the incidence of chronic hydrocephalus was compared among the three groups based on Fisher′s classification.The three groups were followed up for 12 months,and the survival curve was drawn by Kaplan⁃Meier survival analysis method,and the single factor survival analysis was conducted by log rank method.The prognosis of the patients was evaluated by modified Rankin Scale(mRS).Results The incidence of chronic hydrocephalus in group A,B and C was 33.33%,13.16%and 8.07%,respectively(P>0.05).The incidence of chronic hydrocephalus in group A,B and C was 38.46%,31.11%and 8.82%,respectively,with statistical significance(P<0.05).The incidence of chronic hydrocephalus in three groups was statistically signifi⁃cant(P<0.05),33.33%in group A,38.10%in group B and 9.09%in group C),The Bonferroni method was further used to correct the test level,in which the difference between the groups B and C was statistically significant(χ2=8.679,P=0.003).Kaplan⁃Meier survival analysis method was used to draw the survival curve,and log rank method was used for single factor survival analysis.There was a significant difference in survival status among the three groups(P<0.001).After 12 months of follow⁃up,mRS scores of patients with Aash after aneurysm clipping showed that there was a significant difference in mRS scores between group A,group B and group Crespectively(P<0.05),and there was no significant difference in mRS scores between group B and group C Signi
作者
赵义博
寿记新
王冰冰
李龙龙
程森
梁威
蒋文彬
胥飞龙
ZHAO Yibo;SHOU Jixin;WANG Bingbing;LI Longlong;CHENG Sen;LIANG Wei;JIANG Wenbin;XU Feilong(Department of Neurosurgery,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第20期2861-2865,共5页
The Journal of Practical Medicine
关键词
脑积水
终板造瘘
腰大池引流
hydrocephalus
third ventriculostomy
lumbar drainage
