早期顱骨修補聯合腦室-腹腔分流術治療重度腦外傷術后并腦積水的效果分析

林宇國　楊金星　沈衛民

【摘要】 目的：探討早期顱骨修補聯合腦室-腹腔分流術治療重度腦外傷術后并腦積水的臨床效果。方法：選取2015年2月-2017年10月本院收治的重度腦外傷術后并腦積水患者114例作為研究對象，按照隨機數字表法將其分為觀察組（n=57）和對照組（n=57）。觀察組采用早期顱骨修補聯合腦室-腹腔（ventriculo-peritoneal，V-P）分流術，患者先行開顱血腫清除去骨瓣減壓術后2個月內，再行V-P分流聯合顱骨修補術治療。對照組先行V-P分流術，3～6個月后根據患者恢復情況再行顱骨修補術。觀察比較兩組術后1個月的腦積水改善、術后6個月的預后及并發癥發生情況。結果：術后1個月，觀察組的腦積水改善總有效率明顯高于對照組，差異有統計學意義（字2=5.684，P=0.017）。術后6個月，觀察組的格拉斯哥預后評分（GOS）有效率明顯高于對照組，差異有統計學意義（字2=4.293，P=0.038）。觀察組術后并發癥發生率為17.54%（10/57），明顯低于對照組的54.39%（31/57），差異有統計學意義（字2=16.797，P=0.001）。結論：早期顱骨修補聯合腦室-腹腔分流術治療重度腦外傷術后并腦積水效果顯著，安全性高，值得臨床推廣應用。

【關鍵詞】 早期顱骨修補聯合腦室-腹腔分流術; 重度腦外傷; 腦積水

【Abstract】 Objective：To investigate the clinical effect of early skull repair combined with ventriculo-peritoneal shunt in the treatment of hydrocephalus after severe traumatic brain injury.Method：A total of 114 patients with hydrocephalus after severe traumatic brain injury admitted in our hospital from February 2015 to October 2017 were selected as the study objects.According to the random number table method，they were divided into observation group（n=57）and control group（n=57）.The observation group was treated with early early skull repair combined with ventriculo-peritoneal（V-P）shunt.The patients were treated with craniotomy hematoma clearance and decompression of bone flaps removal after operation within 2 months，V-P shunt and skull repair were performed.The control group was treated with V-P shunt，the skull repair was performed after 3-6 months according to the recovery of the patients. The improvement of hydrocephalus after operation 1 month，prognosis after operation 6 months and complications between the two groups were observed and compared.Result：After operation 1 month，the total effective rate of hydrocephalus improvement in the observation group was significantly higher than that in the control group，the difference was statistically significant（字2=5.684，P=0.017）.After operation 6 months，the Glasgow prognosis score（GOS）effective rate of the observation group was significantly higher than that of the control group，the difference was statistically significant（字2=4.293，P=0.038）.The incidence of postoperative complications in the observation group was 17.54%（10/57），which was significantly lower than 54.39%（31/57）in the control group，the difference was statistically significant（字2=16.797，P=0.001）.Conclusion：Early skull repair combined with ventriculo-peritoneal shunt is effective and safe in the treatment of hydrocephalus after severe traumatic brain injury.It is worthy of clinical application.