目的 观察Ommaya囊植入治疗结核性脑膜炎(结脑)合并脑积水的临床转归.方法 选取我院2005-2010年64例结脑合并脑积水患者,随机分为治疗组和对照组,各32例,治疗组行Ommaya囊植入术,术后每天行Ommaya囊穿刺抽液给药,30 d为一个疗程;对照组每周行腰椎穿刺鞘内注药2次.若两组患者脑积水仍加重则行脑室-腹腔(V-P)分流术.根据颅脑CT、MRI显示观察两组患者脑积水的改变情况;随访1年.结果 治疗组中有效27例,无效5例,有效率为84.4%(27/32).对照组分别行经腰椎穿刺鞘内注药及V-P分流术,其中有效19例,无效13例,有效率为59.4%(19/32).两组患者有效率比较,差异有统计学意义(χ2=4.95,P＜0.05).结论 结脑合并进展性、非梗阻性脑积水,经Ommaya囊植入并配合脑室抽液注药治疗,可有效控制部分患者脑积水的发展,避免V-P分流,最终获得临床治愈.%Objective To observe the role of Ommaya reservoir in the treatment of tuberculous meningitis( TBM ) combined with hydrocephalus and clinical prognosis. Methods 64 patients with tuberculous meningitis combined with hydrocephalus admitted to our hospital from 2005 to 2010 were randomly divided into treatment group and control group,with each group 32 cases. Ommaya reservoir was implanted in the patients of treatment group, who were given intrathecal puncture injection each day after operation, with 30 d being a course of treatment. Patients in the control group were given lumbar puncture injection twice a week. Ventriculoperitoneal shunt ( V - P ) will be given if hydrocephalus of the patients in the two groups aggravated. CT and MRI were used to observe the change of hydrocephalus in the patients, who were followed up for one year. Results In treatment group, 27 cases were effective and 5 cases ineffective, the total effective rate was 84. 4% ( 27/32 ). In control group was given lumbar puncture injection and Ventriculoperitoneal shunt. And 19 cases in control group were effective and 13 cases ineffective. The total effective rate was 59. 4%( 19/32 ). The difference of therapeutic effect between the two groups was statistically significant( χ2 = 4. 95 , P < 0. 05 ). Conclusion Tuberculous meningitis combined with progressive, non obstructive hydrocephalus can be effectively controlled by Ommaya reservoir implantation, ventricular drainage and drug injection therapy, which can also effectively control the development of hydrocephalus, avoid V - P shunt and eventually bring clinical cure.
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