摘要
目的对比分析同期和分期行脑室-腹腔分流术(VPS)与颅骨成形术治疗颅脑损伤术后脑积水的效果。方法回顾性分析2015年9月至2018年4月收治的79例颅脑损伤术后脑积水的临床资料。同期行VPS和颅骨成形术47例(同期组),分期行VPS和颅骨成形术32例(VPS后间隔至少3个月进行颅骨成形术;分期组)。术前、术后7 d采用功能独立性评价量表(FIM)、神经行为认知状况测试(NCSE)评价认知功能情况。术后3个月采用GCS评分、GOS评分评定病人意识及预后情况。结果术后7 d,两组FIM评分、NCSE评分均明显升高(P<0.05),同期组明显高于分期组(P<0.05)。术后半年内,同期组术后并发症发生率(12.77%,6/47)明显低于分期组(31.25%,10/32;P<0.05)。术后3个月,同期组GCS评分[(12.02±2.87)分]明显高于分期组[(10.09±1.81)分];(P<0.05),但是GOS评分[(4.24±0.75)分]与分期组[(3.97±0.70)分]无统计学差异(P>0.05)。结论对于颅脑损伤术后脑积水,同期和分期行VPS与颅骨成形术,均可有效改善病人认知功能和预后,而同期手术更具优势。
Objective To compare the clinical effectiveness of simultaneous and separate ventricular-peritoneal shunt(VPS)and cranioplasty(CP)for the traumatic brain injury(TBI)patients with hydrocephalus secondary to decompressive craniectomy(DC).Methods The clinical data of 79 TBI patients with hydrocephalus secondary to DC who were admitted to our hospital from September 2015 to April 2018 were retrospectively analyzed.Of these 79 patients,47 underwent simultaneous VPS and CP(one-stage group),and 32 underwent separate VPS and CP(CP was performed at least 3 months after VPS;two-stage group).The functional independence measure(FIM)score and neurobehavioral cognitive status examination(NCSE)score were used to evaluate the cognitive function before and 7 days after the operation.GCS score and GOS score were used to assess patients'awareness and prognoses 3 months after the operation.Results Seven days after operation,the FIM score and NCSE score of the two groups were significantly increased(P<0.05),and the one-stage group was significantly higher than the two-stage group(P<0.05).Within half a year after the surgery,the incidence of postoperative complications in the one-stage group(12.77%,6/47)was significantly lower than that(31.25%,10/32)in the two-stage group(P<0.05).Three months after the operation,the GCS score[(12.02±2.87)points]in the one-stage group were significantly higher than that[(10.09±1.81)points]in the two-stage group(P<0.05).There was no significant difference in the GOS score between one-stage group[(4.24±0.75)points]and two-stage group[(3.97±0.70)points;P>0.05].Conclusions For the TBI patients with hydrocephalus secondary to DC,simultaneous and separate VPS and CP can effectively improve the patients'cognitive function and prognoses,and simultaneous surgery has more advantages.
作者
邢海涛
袁波
谭占国
XING Hai-tao;YUAN Bo;TAN Zhan-guo(Department of Neurosurgery,Luohe Central Hospital,Luohe 462000,China)
出处
《中国临床神经外科杂志》
2020年第11期750-752,共3页
Chinese Journal of Clinical Neurosurgery
关键词
颅脑损伤
去骨瓣减压术
脑室-腹腔分流术
颅骨成形术
手术时机
Traumatic brain injury
Decompressive craniectomy
Hydrocephalus
Ventriculoperitoneal shunt
Cranioplasty
