脊髓脊膜膨出合并脑积水手术方式的分析

摘要

目的 通过对脊髓脊膜膨出术前合并脑积水手术方式的回顾性分析,探讨其手术方式与最佳疗效的关系.方法 对清华大学玉泉医院自2004年1月至2011年1月收治并有效随访的81例脊髓脊膜膨出合并脑积水病例进行分析.比较3种手术方式:A先期完成神经松解脊髓还纳硬膜修补术,再行脑积水分流术;B先期行脑积水分流术再完成神经松解脊髓还纳硬膜修补术;C一期完成脑积水分流术及神经松解脊髓还纳硬膜修补术.对3种不同手术方式的术后疗效及并发症进行评估.结果 A术式术后并发症较多,存在致残的危险因素,B术式术后疗效及出现并发症较C术式相近,但需分期手术.结论 针对术前高颅内压性脑积水一期完成脑室-腹腔分流及神经松解脊髓还纳硬膜修补术是最佳的治疗方式,对于正常压力脑积水可以暂不分流,视术后颅内压变化而定.%Objective To investigate the correlation between the surgical options and the curative effect.Methods Eighty-one cases who suffered from myelomeningocele with hydrocephalus from Jan 2004to Jan 2011 in Yuquan Hospital affiliated to Tsinghua University were followed.Three different surgical options were applied.Type A,ventriculoperitoneal shunt was performed after the reduction of spinal cord and duraplasty.Type B,ventriculoperitoneal shunt was performed before the reduction of spinal cord and duraplasty.Type C,ventriculoperitoneal shunt and the reduction of spinal cord and duraplasty were performed at one stage.The three surgical options were evaluated by efficacy and complications.Results There were more complications and higher risk of postsurgical disability in the Type A surgical option.The curative effect of the Type B way was similar to the Type C.The Type B required staged operation and increased the risk of infection and shunt pipe obstruction.The Type C were completed by onestage operation and had less complications.Conclusions The one-stage operation of ventriculoperitoneal shunt and the reduction of spinal cord and duraplasty could achieve better efficacy in the treatment of myelomeningocele with hydrocephalus.