CAJ | 학술논문

目的总结脑室镜与腹腔镜在交通性脑积水脑室-腹腔分流术(VPS)中的联合应用中的治疗效果.方法 2010年1月至2014年1月解放军总医院神经外科对209例交通性脑积水患者行VPS治疗,男性93例,女性116例;年龄7个月至79岁,平均38.1岁.病程为20 d至4年,平均(2.4±0.7)个月.手术使用脑室镜辅助脑室端置管,用腹腔镜辅助腹腔端置管.定期进行随访,分流系统的有效率采用Kaplan-Meier曲线进行统计学分析.结果 209例患者接受了255次VPS.所有患者手术均顺利完成,无术中出血或意外损伤转为开颅手术和开腹手术者.术后203例患者脑积水症状有不同程度缓解,13例出现低颅压综合征表现,予以调整压力后好转.所有患者均获得随访,随访时间1个月至4年,中位随访时间2.1年.患者共行翻修手术46次.分流系统1、2、3、4年有效率分别为91.0％、86.7％、83.9％、82.0％.结论在VPS术中,脑室镜和腹腔镜分别能够帮助在脑室内和腹腔内理想位置精确放置分流管,二者联合能获得优良的手术效果.
목적 총결뇌실경여복강경재교통성뇌적수뇌실-복강분류술(VPS)중적연합응용중적치료효과.방법 2010년1월지2014년1월해방군총의원신경외과대209례교통성뇌적수환자행VPS치료,남성93례,녀성116례;년령7개월지79세,평균38.1세.병정위20 d지4년,평균(2.4±0.7)개월.수술사용뇌실경보조뇌실단치관,용복강경보조복강단치관.정기진행수방,분류계통적유효솔채용Kaplan-Meier곡선진행통계학분석.결과 209례환자접수료255차VPS.소유환자수술균순리완성,무술중출혈혹의외손상전위개로수술화개복수술자.술후203례환자뇌적수증상유불동정도완해,13례출현저로압종합정표현,여이조정압력후호전.소유환자균획득수방,수방시간1개월지4년,중위수방시간2.1년.환자공행번수수술46차.분류계통1、2、3、4년유효솔분별위91.0％、86.7％、83.9％、82.0％.결론 재VPS술중,뇌실경화복강경분별능구방조재뇌실내화복강내이상위치정학방치분류관,이자연합능획득우량적수술효과.
Objective To summarize the clinical efficacy of ventriculo-peritoneal shunt (VPS) assisted by neuroendoscopy and laparoscopy for treatment of communicating hydrocephalus.Methods From January 2010 to January 2014,209 cases(male 93,female 116) who suffered communicating hydrocephalus performed VPS with neuroendoscopy and laparoscopy in Department of Neurosurgery of People's Liberation Army General Hospital.The age of the patients were from 7 months to 79 years (mean 38.1 years),average duration were 20 days to 4 years (mean (2.4 ± 0.7) months).Neuroendoscopy and laparoscopy were used to help respectively to place shunt catheter to better position,both in the ventricle and peritoneal cavity.The effect of subsequent shunt system survival was analyzed with Kaplan-Meier survival analysis.Results There were 209 patients received 255 times of VPS.All operations were successfully completed.No craniotomy or open operation were needed for technical-related complications.Forty-six revisions were performed in all patients.After the operation,203 patients with hydrocephalus improved at different level after surgery.Thirteen cases occurred intracranial hypotension syndrome and improved after the pressure adjusted.All patients were followed up for 1 month to 4 years,with a median follow-up time of 2.1 years,while the shunt system efficiencies were 91.0％,86.7％,83.9％ and 82.0％ respectively from the end of the 1 st year to the end of the 4th year.Conclusions For VPS,neuroendoscopy and laparoscopy can respectively help to place shunt catheter to better position,both in the ventricle and peritoneal cavity.Hence,the combination of these two modalities can reduce the failure rate of shunt catheter insertion and has significant impact on shunt system survival.