分期钛金属网修补和脑室-腹腔分流术治疗颅脑损伤后颅骨缺损并脑积水

摘要

目的：总结颅脑损伤后颅骨缺损并脑积水患者分期行脑室-腹腔（V-P）分流术与颅骨修补术治疗的临床经验。方法对44例分期行 V-P 分流术及颅骨修补手术的颅脑损伤后颅骨缺损并脑积水患者的临床资料（38例患者一期先行 V-P 分流术，6例患者一期先行颅骨修补术）进行回顾性分析，对其临床资料、并发症及预后进行总结。结果44例患者无手术死亡。术后发生分流管堵塞1例（2．2％）、颅内感染1例（2．2％）、分流过度出现脑室裂隙样改变2例（4．5％）及并发癫痫或加重3例（6．8％），均经对症处理后缓解。术后1个月进行 GCS 评估，29例（65．9％）神经功能障碍均有不同程度地改善，15例（34．1％）无明显变化；复查 CT 或 MRI 示：原室管膜下水肿均有改善或完全消失，29例（65．9％）脑室基本恢复正常。术后6个月行 GOS 评分：良好23例（52．2％），中残14例（31．8％），重残或植物生存7例（16．0％）。结论颅脑损伤术后颅骨缺损、脑积水、脑膨出严重影响患者预后，分期行 V-P 分流术及颅骨修补手术并发症少，可明显改善患者意识及神经功能障碍，改善患者预后。%Objective To summarize the clinical experiences with staging ventricule-peritoneal (V-P)shunt surgery and cranioplasty for cranial defect and hydrocephalus following craniocere-bral injury.Methods Clinical data of 44 patients who underwent staging V-P shunt surgery and cranioplasty for cranial defect and hydrocephalus following craniocerebral injury were analyzed retrospectively(one-stage V-P shunt surgery was firstly performed in 38 patients,and one-stage cranioplasty in 6 patients).Complications and prognosis were summarized.Results No surgical death occurred in all patients.Among the 44 patients,shunt tube blockage occurred in 1(2.2%), intracranial infection in 1(2.2%),ventricle fissure-like appearance caused by excessive shunt in 2 (4.5%),and epilepsy or exacerbation in 3(6.8%).All complications were alleviated after symp-tomatic treatment.GCS assessment at 1 month after operation showed that neurological dysfunc-tion was relieved in 29 patients(65.9%)and no obvious improvement was found in 15 patients (34.1%).The CT or MRI showed that subependymal edema was alleviated in all patients(100%) and ventricle returned to normal in 29 patients(65.9%).GOS scoring at 6 months after operation showed that good recovery was achieved in 23 patients (52.2%),moderate disability in 14 (31.8%)and severe disability or persistent vegetative state in 7(16.0%).Conclusion Cranial defect,hydrocephalus and encephalocele following craniocerebral injury seriously affect the prog-nosis of patients.The staging V-P shunt surgery and cranioplasty can reduce complications,amel-iorate impaired consciousness,relieve neurological dysfunction and improve the prognosis in pa-tients with cranial defect and hydrocephalus following craniocerebral injury.