同期与分期行颅骨修补术及脑室-腹腔分流术治疗创伤性脑损伤脑积水的疗效比较

Comparison in the efficacy of simultaneous as well as staged cranioplasty and ventriculo-peritoneal shunt in the treatment of traumatic hydrocephalus

  • 摘要:
      目的  观察同期与分期行颅骨修补术及脑室-腹腔(V-P)分流术治疗创伤性脑损伤脑积水患者的临床疗效。
      方法  前瞻性选取接受颅骨修补术及V-P分流术的53例患者作为研究对象,根据是否同期手术将患者分为同期手术组21例和分期手术组32例。比较2组患者一般资料和脑积水改善情况,并比较2组手术前后格拉斯哥昏迷量表(GCS)、格拉斯哥预后量表(GOS)、Karnofsky功能状态量表(KPS)评分变化和术后并发症发生情况。
      结果  2组患者一般资料比较,差异无统计学意义(P>0.05);2组间术前、术后的GCS、GOS、KPS评分比较,差异均无统计学意义(P>0.05);术后,2组GCS、GOS、KPS评分均高于术前,差异有统计学意义(P < 0.05);2组术后脑积水改善情况比较,差异无统计学意义(P>0.05);分期手术组患者的并发症发生率(9.38%)低于同期手术组(33.33%),差异有统计学意义(P < 0.05)。
      结论  同期与分期行颅骨修补术及V-P分流术的临床疗效相当,但分期手术患者的并发症发生率更低,因此创伤性脑损伤脑积水患者建议优先考虑分期手术。

     

    Abstract:
      Objective  To observe the clinical efficacy of simultaneous as well as staged cranioplasty and ventriculo-peritoneal(V-P) shunt in the treatment of traumatic hydrocephalus.
      Methods  A total of 53 patients who underwent cranioplasty and V-P shunt were prospectively selected. The patients were divided into simultaneous operation group (n=21) and staged operation group (n=32). The general clinical data and the improvement of hydrocephalus were compared between the two groups, the changes of Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), Karnofsky Functional Status Scale (KPS) scores before and after operation, and the occurrence of postoperative complications were compared.
      Results  There was no significant difference in general data between two groups (P>0.05). There were no significant differences in the scores of GCS, GOS and KPS before and after operation between the two groups, and no significant difference in the improvement of hydrocephalus between the two groups after operation was observed(P>0.05). After operation, GCS, GOS and KPS scores of two groups were higher than those before operation, the differences were statistically significant (P < 0.05). The incidence of complications in the staged operation group (9.38%) was significantly lower than that in the simultaneous operation group (33.33%), and the difference was statistically significant (P < 0.05).
      Conclusion  Simultaneous cranioplasty, staged cranioplasty and V-P shunt have similar clinical efficacy, but the incidence of complications in the staged operation group is lower, so the patients with traumatic hydrocephalus should be given staged surgery in priority.

     

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