脑室-腹腔分流术联合颅骨修补术同期治疗脑积水患者合并颅骨缺损的疗效

摘要

目的 探讨同期脑室-腹腔(VPS)分流术联合颅骨修补术治疗脑积水合并颅骨缺损的疗效.方法 对2013年1月至2015年12月40例脑积水合并颅骨缺损患者(同期组)同期实施VPS联合数字化成形三维钛网颅骨修补术,并回顾性分析2010年1月至2012年12月分期实施V-P分流术与颅骨修补术的40例脑积水合并颅骨缺损患者(分期组)的临床资料,比较两组的治疗效果.结果 同期组手术时间、住院费用少于分期组,差异有统计学意义(P＜0.05).两组术后脑灌注异常指数、脑积水程度均较术前显著改善,差异有统计学意义(P＜0.05),但两组间比较差异未见统计学意义(P＞0.05).两组术后Salmon预后有效率比较差异未见统计学意义(P＞0.05);同期组并发症发生率少于对照组,差异有统计学意义(P＜0.05).结论 对脑积水合并颅骨缺损患者同期实施VPS与颅骨修补术疗效与分期手术相当,但同期手术时间较短、住院费用较低,且并发症较少,更有利于患者术后康复.%Objective To investigate the effect of one-stage ventricle-peritoneal shunt (VPS) combined with cranioplasty on hydrocephalus complicated with skull defects.Methods Forty patients with hydrocephalus complicated with skull defects from January 2013 to December 2015 (the one-stage group) underwent one-stage VPS and numerical forming a three-dimensional titanium mesh skull repair surgery,and the clinical data of 40 patients with hydrocephalus and skull defects from January 2010 to December 2012 (the two-stage group)who underwent two-stage surgery were retrospectively analyzed.The treatment effects of the two groups were compared.Results The operative time in the one-stage group was shorter than that in the two-stage group,the cost of hospitalization was also less than that in the twostage group,the differences were significant (P ＜ 0.05).The abnormal brain perfusion index and hydrocephalus level of the two groups significantly improved compared with preoperative,the differences were significant(P ＜ 0.05),but there was no significant difference between the two groups postoperatively(P ＞0.05).There was no significant difference in efficiency between the two groups(P ＞ 0.05).The complication rate in the one-stage group was lower than that in the two-stage group,the difference was significant (P ＜ 0.05).Conclusions One-stage ventricle-peritoneal shunt and cranioplasty has the same effect with two-stage surgery on hydrocephalus complicated with skull defects,but the operation time of onsestage surgical is shorter,and hospital costs is less,and it has fewer complications,which is more conducive to the rehabilitation of patients after surgery.