[1]张永明　赵鹏程　黄振山　许少年　邓鹏程　施　建.颅脑损伤继发正常压力脑积水的临床治疗分析[J].中国临床神经外科杂志,2020,(04):203-205.[doi:10.13798/j.issn.1009-153X.2020.04.004]
　ZHANG Yong-ming,ZHAO Peng-cheng,HUANG Zhen-shan,et al.Clinical analysis of normal pressure hydrocephalus secondary to tranmatic brain injury[J].,2020,(04):203-205.[doi:10.13798/j.issn.1009-153X.2020.04.004]
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颅脑损伤继发正常压力脑积水的临床治疗分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年04期
页码:
203-205
栏目:
论著
出版日期:
2020-04-30

文章信息/Info

Title:
Clinical analysis of normal pressure hydrocephalus secondary to tranmatic brain injury
文章编号:
1009-153X（2020）04-0203-03
作者:
张永明　赵鹏程　黄振山　许少年　邓鹏程　施　建
230041 合肥，安徽省第二人民医院神经外科（张永明、邓鹏程、施　建）；230031 合肥，安徽医科大学解放军临床学院（赵鹏程）；230031 合肥，中国人民解放军联勤保障部队第901医院神经外科（黄振山、许少年）
Author(s):
ZHANG Yong-ming1;  ZHAO Peng-cheng2;  HUANG Zhen-shan3;  XU Shao-shan2;  DENG Peng-cheng1;  SHI Jian1.
1. Department of Neurosurgery, Anhui No.2 Provincal People's Hospital, Hefei 230041, China; 2. Department of Neurosurgery, PLA Clinical College, Anhui Medicine University, Hefei 230031, China; 3. Department of Neurosurgery, The 901st Hospital of The Joint Logistics Support Force, PLA, Hefei 230031, China
关键词:
颅脑损伤; 正常压力脑积水; 腰大池-腹腔分流术; 脑室-腹腔分流术; 疗效
Keywords:
Traumatic brain injury;  Normal pressure hydrocephalus;  Lumboperitoneal shunt;  Ventriculoperitoneal Shunt
分类号:
R 742.7; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2020.04.004
文献标志码:
A
摘要:
目的 探讨颅脑损伤继发正常压力脑积水的治疗方法及疗效。方法 回顾性分析2017年1月至2019年9月收治的69例颅脑损伤继发正常压力脑积水的临床资料。采用腰大池-腹腔分流术（LPS）治疗31例（LPS组），采用脑室-腹腔分流术（VPS）治疗23例（VPS组），保守治疗15例（保守组）。所有病例均随访3个月以上，对比分析各组围手术期并发症、术后3个月头颅CT平扫、CT灌注成像参数[脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）、达峰时间（TTP）]、GOS评分、日常生活能力量表（ADL）评分。结果 LPS组和VPS组均手术成功，无手术死亡病例。保守组死亡1例。术后3个月，LPS组和VPS组Evan’s指数、戴帽征高度、CBV、CBF等指标均明显优于保守组（P<0.05），但是LPS组和VPS组之间均无统计学差异（P>0.05）。LPS组并发症总发生率（12.90%，4/31）和VPS组（39.13%，9/23）明显高于保守组（0%；P<0.05），但是LPS组明显低于VPS组（P<0.05）。术后3个月，LPS组和VPS组GOS评分及ADL评分均显著高于保守组（P<0.05），但是LPS组和VPS组之间无统计学差异（P>0.05）。结论 对于颅脑损伤继发正常压力脑积水，建议积极手术治疗，VPS和LPS均是有效的方法，而LPS并发症相对更少。
Abstract:
Objective To explore the treatment methods of normal pressure hydrocephalus (NPH) secondary to traumatic brain injury (TBI) and to analyze their clinical effects. Methods The clinical data of 69 patients with NPH secondary to TBI who were admitted to our hospital from January 2017 to September 2019 were analyzed retrospectively. Of these patients, 31 patients were treated with lumbar cistern-peritoneal shunt (LPS group), 23 with ventricular-abdominal shunt (VPS group), and 15 with conservative treatment (conservative group). All the patients were followed up for more than 3 months, and the perioperative complications, the results of postoperative CT imaging, the CT perfusion imaging parameters including cerebral blood volume (CBV), cerebral blood flow (CBF), average pass Time (MTT), and time to peak (TTP), the GOS score, and the ADL score were compared among the three groups 3 months after the operation. Results The operations were successful in all the patients of both the LPS and VPS groups, and there were no patients died from the operation. One patient died in the conservative group. The Evan's index, the height of the wearing cap sign, CBV, and CBF in both the LPS and VPS groups were significantly better than those in the conservative group (P<0.05), but there was no statistical difference between the LPS and VPS groups (P>0.05). The total rate of complications in the VPS group (39.13%, 9/23) was significantly higher than that (12.90%, 4/31) in the LPS group (P<0.05). The total rates of complications in both the VPS and LPS groups were significantly higher than that (0%) in the conservative group (P<0.05). The GOS scores and ADL scores in both the LPS and VPS groups were significantly higher than those in the conservative group (P<0.05), but there was no statistical difference between the LPS and VPS groups (P>0.05). Conclusion The NPH secondary to TBI should be treated using the operation. Both VPS and LPS are effective methods for NPH secondary to TBI, and the LPS has fewer complications compared with the VPS.

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备注/Memo

备注/Memo:
基金项目：安徽省重点研究与开发项目（201904a07020108） 通讯作者：张永明，E-mail：zymhf2966@163.com（2020-02-12收稿，2020-03-03修回）
更新日期/Last Update: 2020-04-10