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Received:March 20, 2019 Published Online:January 20, 2020
Received:March 20, 2019 Published Online:January 20, 2020
中文摘要: 目的 探讨不同分流管应用于管脑室-腹腔(V-P)分流术治疗特发性正常压力脑积水(iNPH)患者的临床效果及其影响因素。
方法 回顾性分析2014年1月至2017年1月收治的iNPH患者69例的临床资料。所有患者均按国际和日本iNPH诊疗指南诊断为很可能或可能iNPH,术前均腰椎穿刺(腰穿)脑脊液放液试验阳性,均采用V-P分流术进行治疗;按分流管型号的不同,使用可调压抗虹吸分流管50例(可调压抗虹吸组),不可调压抗虹吸分流管19例(抗虹吸组);根据改良Rankin量表对两组患者的临床效果进行评估并分析其影响因素。
结果 69例iNPH患者在随访时有8例失访,余61例治疗总有效率为83.6%(51/61)。可调压抗虹吸组45例患者疗效(显效62.2%,有效24.5%,无效13.3%)明显优于抗虹吸组16例患者(显效18.7%,有效56.3%,无效25.0%),差异有统计学意义(P=0.006);性别、年龄、病程分期以及术前腰穿脑脊液压力对术后疗效并无显著影响(P均>0.05),可调压抗虹吸管是影响V-P分流术疗效的有利因素(P<0.01)。
结论 V-P分流治疗iNPH安全、有效;可调压抗虹吸分流管临床疗效较佳,可作为首选,术后对分流过度或分流不足的患者很容易进行调整,鉴于资料有限,尚未发现性别、年龄、病程以及术前脑脊液压力对术后疗效有显著影响。
中文关键词: 正常压力脑积水,特发性 抗虹吸分流管 可调压 脑室-腹腔分流术
Abstract:Objective To investigate the clinical effects and influencing factors of ventriculo-peritoneal (V-P) shunt with different shunt tubes in patients with idiopathic normal pressure hydrocephalus(iNPH).
Methods The clinical data of 69 patients with iNPH treated from January 2014 to January 2017 were analyzed retrospectively.All patients were diagnosed as "possible" and "probable" iNPH according to the International and Japanese Guidelines for the Diagnosis and Treatment of iNPH,and were positive in cerebrospinal fluid tap test before operation and received V-P shunt.According to the type of shunt tube,50 cases of shunt tube with adjustable pressure anti-siphon device(ASD) (adjustable pressure ASD group),and 19 cases of shunt tube with non-adjustable pressure anti-siphon device (ASD group) were used.
The Modified Rankin scale was used to evaluate the clinical effects between two groups,and the influencing factors of prognosis were analyzed.
Results Of the 69 patients with iNPH,8 were lost to follow-up,and the total effective rate of the remaining 61 patients was 83.6% (51/61).The significant effective rate,effective rate and ineffective rate were 62.2%,24.5% and 13.3%,respectively in adjustable pressure ASD group and 18.7%,56.3% and 25.0%,respectively in ASD group.There were statistical differences between two groups(P=0.006).The research showed that gender,age,stage of disease,and cerebrospinal fluid pressure measured by lumbar puncture had no obvious influences on postoperative outcome(all P>0.05),and adjustable ASD was a favaurite factor affecting the efficacy of V-P shunt(P<0.01).
Conclusions V-P shunt is safe and effective in the treatment of iNPH,and the adjustable pressure ASD is better in clinical practice and can be used as the first choice.It is easy to adjust for the patients with excessive or insufficient shunt after operation.In view of the limited data,it has not been found that gender,age,course of disease and preoperative pressure have significant impacts on the postoperative outcome.
keywords: Normal pressure hydrocephalus,idiopathic Anti-siphon device(shunt tube) Adjustable pressure Ventriculo-peritonea shunt
文章编号: 中图分类号: 文献标志码:B
基金项目:
Author Name | Affiliation |
GUO Hong-qu,ZHANG Wang,YAN Shi,SHEN Hong | Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150001,China |
Author Name | Affiliation |
GUO Hong-qu,ZHANG Wang,YAN Shi,SHEN Hong | Department of Neurosurgery,the First Affiliated Hospital of Harbin Medical University,Harbin,Heilongjiang 150001,China |
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