本文選題：梗阻性腦積水 + 腦室腹腔分流術(shù)��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]分析神經(jīng)內(nèi)鏡手術(shù)治療梗阻性腦積水的臨床療效,并評(píng)價(jià)其臨床價(jià)值。[方法]回顧性分析2011年12月至2016年12月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)外二科共90例梗阻性腦積水患者的臨床資料,90例患者中神經(jīng)內(nèi)鏡手術(shù)組47例與腦室腹腔分流手術(shù)組(VPS組)43例。根據(jù)隨訪結(jié)果比較兩組手術(shù)時(shí)間、住院時(shí)間、有效率、KPS評(píng)分、術(shù)后并發(fā)癥、死亡率等指標(biāo),并進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]1、神經(jīng)內(nèi)鏡組平均手術(shù)時(shí)間為(90.09±32.34)分鐘,平均住院時(shí)間為(20.40±7.91)天;分流組平均手術(shù)時(shí)間為(117.60±41.74)分鐘,平均住院時(shí)間(27.33±17.40)天;兩組相比,神經(jīng)內(nèi)鏡組患者的平均手術(shù)時(shí)間和住院時(shí)間較分流組短,并具有統(tǒng)計(jì)學(xué)意義(P0.05)。2、內(nèi)鏡組手術(shù)有效率為100.00%,較分流組手術(shù)有效率83.72%高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);內(nèi)鏡組平均KPS評(píng)分為(97.66±14.63)高于分流組平均KPS評(píng)分(63.95±36.98),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3、兩組術(shù)后并發(fā)癥比較,神經(jīng)內(nèi)鏡組腦室積血、堵管、顱內(nèi)感染發(fā)生率低于分流組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4、兩組死亡率對(duì)比,內(nèi)鏡組為2.13%,明顯低于分流組為18.60%,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]神經(jīng)內(nèi)鏡手術(shù)治療梗阻性腦積水,不僅可以解決腦脊液的循環(huán)障礙,同時(shí)還可處理部分原發(fā)病因。內(nèi)鏡手術(shù)在提高臨床療效、改善患者遠(yuǎn)期生活質(zhì)量,減少術(shù)后并發(fā)癥、降低死亡率等方面優(yōu)于VPS手術(shù),然而內(nèi)鏡手術(shù)并不能完全取代VPS手術(shù)。神經(jīng)內(nèi)鏡手術(shù)符合現(xiàn)代神經(jīng)外科微創(chuàng)、精準(zhǔn)的治療理念。
[Abstract]:Objective: to evaluate the clinical value of endoscopic neurosurgery in the treatment of obstructive hydrocephalus. [methods] the clinical data of 90 patients with obstructive hydrocephalus from December 2011 to December 2016 in Department of external Neurology, first affiliated Hospital of Kunming Medical University were retrospectively analyzed. There were 43 cases in VPS group. The operative time, hospital stay, effective rate and KPS score, postoperative complications and mortality were compared between the two groups according to the results of follow-up. [results] 1. The average operative time and hospital stay were 90.09 鹵32.34 and 20.40 鹵7.91 days in the endoscopic group and 117.60 鹵41.74 minutes and 27.33 鹵17.40 days in the shunt group, respectively. The average operative time and hospitalization time of the patients in the endoscopic group were shorter than those in the shunt group, and there was statistically significant difference between the two groups. The effective rate of the endoscopic group was 100.00,83.72%, which was higher than that of the shunt group (83.72%). The average KPS score of endoscopic group was 97.66 鹵14.63), which was higher than that of shunt group (63.95 鹵36.98). The incidence of intracranial infection was lower than shunt group, the difference was statistically significant (P 0.05). The mortality rate of endoscopic group was 2.13, and that of shunt group was 18.60. The difference was statistically significant (P 0.05). [conclusion] Endoscopic neurosurgery for obstructive hydrocephalus can not only solve cerebrospinal fluid circulatory disorders, but also deal with some primary causes. Endoscopic surgery is superior to VPS in improving clinical efficacy, improving long-term quality of life, reducing postoperative complications and reducing mortality. However, endoscopic surgery can not completely replace VPS surgery. Endoscopic neurosurgery accords with modern neurosurgery minimally invasive and accurate treatment concept.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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