文章摘要
蒋铭,张志国,李博,等.不同分流方案联合颅骨修补治疗颅脑损伤减压术后交通性脑积水疗效比较[J].安徽医药,2020,24(1):58-61.
不同分流方案联合颅骨修补治疗颅脑损伤减压术后交通性脑积水疗效比较
Clinical effects and safety comparison of different kinds of shunt plus cranioplasty in the treatment of patients with communicating hydrocephalus after craniocerebral injury decompression
  
DOI:10.3969/j.issn.1009?6469.2020.01.015
中文关键词: 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
英文关键词: Hydrocephalus  Craniocerebral trauma  Decompressive craniectomy/adverse effects  Ventriculoperitoneal shunt  Treatment outcome  Staging operation  Simultaneous operation
基金项目:
作者单位E-mail
蒋铭 重庆市开州区人民医院神经外科重庆405400  
张志国 重庆市开州区人民医院神经外科重庆405400  
李博 重庆市开州区人民医院神经外科重庆405400  
李军 重庆市开州区人民医院神经外科重庆405400 17353094@qq.com 
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中文摘要:
      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。
英文摘要:
      Objective To investigate the influence of simultaneous operation and staging operation for shunt plus cranioplasty onthe 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.
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