徐才邦

[摘要] 目的 比較分析腦積水合并顱骨缺損同期手術(shù)與分期手術(shù)的效果。 方法 選擇2012年2月～2014年1月廣西壯族自治區(qū)江濱醫(yī)院收治的54例腦積水合并顱骨缺損患者，根據(jù)隨機數(shù)字表法將其隨機分為同期手術(shù)組（27例）和分期手術(shù)組（27例），同期手術(shù)組同期行腦室-腹腔分流術(shù)和顱骨修補術(shù)，分期手術(shù)組在腦室-腹腔分流術(shù)后4周～7個月后行顱骨修補術(shù)，比較兩組患者分流效果、神經(jīng)功能恢復(fù)情況、并發(fā)癥發(fā)生率、生活質(zhì)量、醫(yī)療費用、再次手術(shù)情況。 結(jié)果 兩組分流效果比較差異無統(tǒng)計學(xué)意義（P > 0.05）；同期手術(shù)組神經(jīng)功能恢復(fù)的優(yōu)良率顯著高于分期手術(shù)組，差異有統(tǒng)計學(xué)意義（P < 0.05）；同期手術(shù)組并發(fā)癥發(fā)生率為11.11%，分期手術(shù)組為29.63%，兩組比較差異無統(tǒng)計學(xué)意義（P > 0.05）；同期手術(shù)組健康調(diào)查簡表（SF-36）中的心理健康和總體健康評分均顯著高于分期手術(shù)組（P < 0.05）；同期手術(shù)組的醫(yī)療費用顯著低于分期手術(shù)組（P < 0.05）；兩組均有1例患者行再次手術(shù)。 結(jié)論 雖然同期行腦室-腹腔分流術(shù)和顱骨修補術(shù)在腦積水合并顱骨缺損中的分流效果與分期手術(shù)無異，但它在神經(jīng)功能恢復(fù)、并發(fā)癥、患者心理健康和醫(yī)療費用上更具優(yōu)勢，值得臨床優(yōu)先考慮使用。

[關(guān)鍵詞] 腦積水；顱骨缺損；腦室-腹腔分流術(shù)；顱骨修補術(shù)；同期手術(shù)；分期手術(shù)

[中圖分類號] R742.7 [文獻標(biāo)識碼] A [文章編號] 1673-7210（2016）12（b）-0076-04

Effect comparison of synchronous operation and asynchronous operation for hydrocephalus combined with skull defect

XU Caibang

Department of Neurosurgery， Jiangbin Hospital， Guangxi Zhuang Autonomous Region， Nanning 530021， China

[Abstract] Objective To compare and analyze the effects of synchronous operation and asynchronous operation for hydrocephalus combined with skull defect. Methods Fifty-four patients with hydrocephalus combined with skull defect admitted to Jiangbin Hospital of Guangxi Zhuang Autonomous Region from February 2012 to January 2014 were selected and randomly divided into synchronous operation group （27 cases） and asynchronous operation group （27 cases） by random number table method. The synchronous operation group was taken ventriculo peritoneal shunt and skull prosthesis at the same time， while the asynchronous operation group was taken skull prosthesis at 4 weeks to 7 months after ventriculo peritoneal shunt. The shunt effect， conditions of nerve function recovery， incidence of complications， quality of life ， medical costs， conditions of reoperation in the two groups were compared. Results The difference of shunt effect between the two groups was not statistically significant （P > 0.05）； the excellent rate of nerve function recovery in the synchronous operation group was higher than that of asynchronous operation group， the difference was statistically significant （P < 0.05）； the incidence of complications in the synchronous operation group was 11.11%， which of asynchronous operation group was 29.63%， the difference between the two groups was not statistically significant （P > 0.05）； the scores of psychological health and general health of the MOS item short from health survey （SF-36） in the synchronous operation group were all higher than those of asynchronous operation group （P < 0.05）； the medical cost of synchronous operation group was significantly lower than that of asynchronous operation group （P < 0.05）； both groups had one case of reoperation. Conclusion The shunt effect of ventriculo peritoneal shunt and skull prosthesis at the same time for hydrocephalus combined with skull defect is similar to that of asynchronous operation， but it has more advantages in nerve function recovery， complications， psychological health and medical costs， which is worthy of clinical priority use.