脑室腹腔分流术后脑积水患者再次行神经内镜下三脑室底造瘘的疗效评价

Evaluation of efficacy of endoscopic third ventriculostomy for patients with hydrocephalus after ventriculoperitoneal shunt

摘要:

摘要：目的 评价脑室腹腔分流术后患者行神经内镜下三脑室底造瘘（ETV）治疗梗阻性脑积水的临床效果。方法 回顾性分析2010年6月－2016年10月该科行三脑室底造瘘的102例梗阻性脑积水患者。其中，男63例，女39例，年龄11～54岁，平均32.6岁。依据既往是否行过脑室腹腔分流手术分为两组，首次ETV组75例，分流术后ETV组（脑室腹腔分流术后引流管堵塞或引流管外露的梗阻性脑积水患者）27例，首次ETV组直接行ETV，分流术后ETV组行神经内镜辅助下脑室腹腔分流管拔除及第三脑室底造瘘术治疗。术后门诊随访并评价手术治疗效果及并发症发生率。结果 102例患者均获随访，随访时间3～24个月，平均11.3个月，对于术前症状首次ETV组与分流术后ETV组均能得到改善，术后并发症（硬膜下积液、发热和颅内感染）发生率的比较，差异无统计学意义（P >0.05），近期疗效两组差异无统计学意义（P >0.05），远期疗效两组差异具有统计学意义（P <0.05），且首次ETV组疗效均优于分流术后ETV组，分流术后ETV治疗组比首次ETV组具有更高的症状复发率和再手术率（P <0.05）。结论 对于梗阻性脑积水患者行ETV后症状改善明显，失败率相对较低。对于梗阻性脑积水若既往接受过分流手术，再次行ETV仍有部分患者能得到较好疗效，但术后症状复发风险更高，需再次手术可能性较大。

Abstract:

Abstract: Objective To evaluate the clinical effect of endoscopic third ventriculostomy in treatment of obstructive hydrocephalus after ventriculoperitoneal shunt. Methods The clinical data of 102 cases of obstructive hydrocephalus from June 2010 to October 2016 were reviewed. There were 63 males and 39 females. The average age was 32.6 years (range, 11 to 54 years). They were divided into two groups. There were 75 cases in group of EVT for the first time (Primary ETV) and 27 cases in group of ETV after the shunt (Secondary ETV). The postoperative follow-up was carried out, the effect of surgical treatment and the incidence of complications were evaluated. Results All the 102 patients were followed up for a period of 3 ~ 24 months (mean, 11.3 months). The pre-operation symptoms were improved in both Primary ETV group and Secondary ETV group. There was no significant difference in the incidence of postoperative complications in the two groups (P > 0.05). There was no significant difference between the two groups in the short term effects (P > 0.05). There were statistically significant differences between the two groups in long term effects (P < 0.05). The effects of Primary ETV group were better than the Secondary ETV group. The recurrence rate and re-operation rate of the Secondary ETV group were higher than that in the Primary ETV group. Conclusion The symptoms of patients with obstructive hydrocephalus improved significantly after ETV operation. The rate of failure is relatively low. In the case of obstructive hydrocephalus who had previously received shunt,the operation of ETV still had a good effect on some patients. The risk of recurring symptoms is higher after operation and the possibility of reoperation is more likely.