摘要
目的探讨不同手术方式治疗颅脑损伤去骨瓣减压术后脑积水的临床效果与安全性。方法选取科室2017年1月—2018年12月收治的60例颅脑损伤去骨瓣减压术后合并交通性脑积水的患者作为研究对象,在满足伦理学及患者知情权的基础上,以1:1的方法将对象分为试验组和对照组,每组30例;对照组给予脑室腹腔分流术并同期进行颅骨修补术,试验组先行脑室-腹腔分流术后择期行颅骨修补术,比较两组患者的手术效果。结果资料统计显示:试验组患者的去骨瓣至颅骨修补平均时间为(103.53±22.79)d,脑室-腹腔分流术平均时间(65.51±18.12)min,颅骨修补术平均时间为(121.56±43.19)min,对照组与之相对应的三项指标分别为(107.82±24.35)d、(64.70±16.63)min、(127.39±51.39)min,三项指标组间比较均无统计学意义(P>0.05);试验组患者术前GOS评分(2.41±0.41)分,治疗后GOS评分(4.32±0.31)分,对照组术前GOS评分(2.45±0.46)分,治疗后GOS评分(3.59±0.56)分,两组患者治疗前GOS评分无统计学意义(P>0.05),治疗后均明显改善但试验组评分优于对照组,组间有统计学意义(P<0.05);试验组生存状态各指标差异无统计学意义(P>0.05),试验组术后并发症率10.00%,低于对照组的23.33%,组间差异有统计学意义(P<0.05)。结论脑室-腹腔分流术后择期行颅骨修补术治疗颅脑损伤去骨瓣减压术后脑积水的治疗效果和安全性优于脑室腹腔分流术并同期进行颅骨修补术,方法值得借鉴。
Objective To explore the clinical effect and safety of different surgical methods in the treatment of hydrocephalus after decompressive craniotomy.Methods From January 2017 to December 2018,60 patients with communicating hydrocephalus after craniocerebral injury decompressive surgery were selected as the research objects.On the basis of meeting the ethics and patients'right to know,the subjects were divided into experimental group and control group by 1:1 method,30 cases in each group.The control group was given ventriculoperitoneal shunt and skull repair at the same time,and In the experimental group,cranioplasty was performed after ventriculoperitoneal shunt.The surgical results of the two groups were compared.Results Data statistics showed that the average time from osteotomy to cranial repair was(103.53±22.79)d,the average time of ventriculoperitoneal shunt was(65.51±18.12)min and the average time of cranial repair was(121.56±43.19)min in the experimental group,and the corresponding three indexes in the control group were(107.82±24.35)d,(64.70±16.63)min and(127.39±51.39)min,respectively.There was no statistical significance between the two groups(P>0.05);The preoperative GOS score of the experimental group was(2.41±0.41),the postoperative gos score was(4.32±0.31),the preoperative GOS score of the control group was(2.45±0.46),and the postoperative GOS score was(3.59±0.56).There was no statistical significance between the two groups(P>0.05),but the score of the experimental group was better than that of the control group.There was statistical significance between the two groups(P<0.05);Each index of survival state in the experimental group was better than that in the control group,but there was no statistical difference(P>0.05).The postoperative complication rate of the experimental group was 10.00%,which was lower than that of the control group(23.33%),and there was statistical significance between the groups(P<0.05).Conclusion selective cranioplasty after ventriculoperitoneal shunt is better than ventriculoperitoneal shunt and cranioplasty at the same time in the treatment of hydrocephalus after decompressive craniectomy.
作者
周文晓
ZHOU Wenxiao(Neurosurgery Department,Dezhou Lingcheng People's Hospital,Dezhou Shandong 253500,China)
出处
《中国继续医学教育》
2020年第33期115-119,共5页
China Continuing Medical Education
关键词
颅脑损伤
去骨瓣减压术
脑积水
脑室-腹腔分流术
颅骨修补术
同期手术
craniocerebral injury
decompressive craniectomy
hydrocephalus
ventriculoperitoneal shunt
cranioplasty
simultaneous operation
