CAJ | 학술논문

目的探讨水环境神经内镜(脑室镜)手术并发症的防治方法.方法回顾性分析10年内由第一作者主刀的425例脑室镜手术并发症的情况.结果 425例患者共行脑室镜手术431次,其中36例(8.5%)患者发生手术并发症67例次.36例患者均获得随访,平均随访时间19.3个月.内镜工作早期(前50例)并发症发生率为18.0%,后期(50例之后的375例)为7.2%.其中头皮切口问题(愈合不良、脑脊液漏和感染等)的发生率为4.2%,硬膜下积液3.3%,颅内出血2.4%,颅内感染2.1%,脑神经损伤1.9%,下丘脑损伤0.7%,脑梗死0.5%,中脑损伤0.5%,丘脑损伤0.2%.其中24例(5.6%)并发症为暂时性;12例(2.8%)为永久性.永久性并发症中8例(1.9%)后果严重,包括死亡2例(0.5%).结论熟练掌握脑室镜手术技术并严格掌握手术适应证之后,脑室镜手术比较安全.多数并发症是暂时性的.对1岁以下的婴儿要认真对待手术切口,争取切口一期愈合.重度脑积水和巨大蛛网膜囊肿患者,术后易发生硬膜下积液,应特别重视相关手术技巧.
목적 탐토수배경신경내경(뇌실경)수술병발증적방치방법.방법 회고성분석10년내유제일작자주도적425례뇌실경수술병발증적정황.결과 425례환자공행뇌실경수술431차,기중36례(8.5%)환자발생수술병발증67례차.36례환자균획득수방,평균수방시간19.3개월.내경공작조기(전50례)병발증발생솔위18.0%,후기(50례지후적375례)위7.2%.기중두피절구문제(유합불량、뇌척액루화감염등)적발생솔위4.2%,경막하적액3.3%,로내출혈2.4%,로내감염2.1%,뇌신경손상1.9%,하구뇌손상0.7%,뇌경사0.5%,중뇌손상0.5%,구뇌손상0.2%.기중24례(5.6%)병발증위잠시성;12례(2.8%)위영구성.영구성병발증중8례(1.9%)후과엄중,포괄사망2례(0.5%).결론 숙련장악뇌실경수술기술병엄격장악수술괄응증지후,뇌실경수술비교안전.다수병발증시잠시성적.대1세이하적영인요인진대대수술절구,쟁취절구일기유합.중도뇌적수화거대주망막낭종환자,술후역발생경막하적액,응특별중시상관수술기교.
Objective To study the prophylaxis and control techniques of complications occurred in water-medium neuroendoscopic (or ventriculoscopic) operations, in an effort to build up our confidence in carrying out these kinds of operations. Methods Clinical records and follow-up data of 425 cases underwent ventriculoscopic operations, accomplished by the senior surgeon in the past 10 years, were investigated retrospectively with priority on the complications. Results 431 ventriculoscopic operations were carried out in 425 cases, 67 times complications were happened in 36 cases (8.5%), and all these patients were followed up for a mean time of 19.3 months. Complication rate was 18.0% in the early stage of neuroendoscopic practice (the first 50 cases), and 7.2% in the last stage (other 375 cases followed the first 50 cases). The complications were scalp incision problems (4.2% , including bad healing, cerebral spinal fluid leakage and infection), subdural hygroma (3.3%), intracranial hemorrhage (2.4%), intracranial infection (2.1%), cranial nerve injury (1.9%), hypothalamus injury (0.7%), cerebral infarction (0.5%), midbrain injury (0.5%), and thalamencephalon injury (0.2%). Twenty-four complications (5.6%) were temporary, and 12 (2.8%) were permanent. Eight (1.9%)of the 12 permanent cases were in serious consequences, and 2 (0.5%)of them died. Conclusion Ventriculoscopic operations are safe.Most complications are temporary, and the life-endangering complications are rare. In child less than 1 year old, the head incision must be managed seriously. In order to reduce the infectious rate, surgeons must exert every effort to make the scalp healed well. Post-operative subdural hygromas are likely to be happened in cases with serious hydrocephalus or large intracranial arachnoid cysts, associated surgical techniques must be stressed on during the operations.