术前分流术治疗脑肿瘤合并脑积水临床分析
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摘要
目的分析术前分流术治疗脑肿瘤合并脑积水的临床效果。方法将80例脑部肿瘤合并脑积水患者随机分为对照组(38例)和实验组(42例),对照组应用反复腰椎穿刺放液,实验组根据病情行脑室-腹腔分流术。观察2组颅内压、脑脊液SP100蛋白浓度、疗效、住院时间及并发症发生情况。结果实验组总有效率显著高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05);分流术后7 d、14 d颅内压、脑脊液SP100蛋白浓度较术前明显降低,与对照组相比差异有统计学意义(P<0.05);2组住院时间差异无统计学意义(P>0.05)。结论术前分流术可提高脑肿瘤合并脑积水患者耐受性,缓解颅内高压,有效改善临床症状,降低围手术期并发症发生率。
Objective To investigate the curative effect of shunt treatment of brain tumors in patients with hydrocephalus.Methods 80 cases of patients with brain tumor combined with hydrocephaluswere randomly divided into experimental group(42 cases) and control group(38 cases),control group was given repeated lumbar paracentesis,experimental group was given ventriculo-peritoneal shunt according to patients' condition.The intracranial pressure,cerebrospinal fluid SP100 protein concentration,patient efficacy,hospitalization time and complicationsoftwo groups were observed.Results The total effective rate in shunt group was significantly higher than that of control group,the difference was statistically significant(P<0.05);at 7 d and 14 d post-shunt,fund intracranial pressure and the concentration of SP100 protein in CSF decreased significantly,there were obvious advantages compared with the control group(P<0.05);the hospitalization of two groups was not statistically significant(P>0.05).Conclusion Preoperative shunt can improve preoperative tolerance of patients with brain tumor combined and hydrocephalus,relieve preoperative intracranial hypertension,effectively improve clinical symptoms,and reduce the incidence of perioperative complications.It is an effective way of auxiliary operation.
Objective To investigate the curative effect of shunt treatment of brain tumors in patients with hydrocephalus.Methods 80 cases of patients with brain tumor combined with hydrocephaluswere randomly divided into experimental group(42 cases) and control group(38 cases),control group was given repeated lumbar paracentesis,experimental group was given ventriculo-peritoneal shunt according to patients' condition.The intracranial pressure,cerebrospinal fluid SP100 protein concentration,patient efficacy,hospitalization time and complicationsoftwo groups were observed.Results The total effective rate in shunt group was significantly higher than that of control group,the difference was statistically significant(P<0.05);at 7 d and 14 d post-shunt,fund intracranial pressure and the concentration of SP100 protein in CSF decreased significantly,there were obvious advantages compared with the control group(P<0.05);the hospitalization of two groups was not statistically significant(P>0.05).Conclusion Preoperative shunt can improve preoperative tolerance of patients with brain tumor combined and hydrocephalus,relieve preoperative intracranial hypertension,effectively improve clinical symptoms,and reduce the incidence of perioperative complications.It is an effective way of auxiliary operation.
引文
[1] DAKURAH T K,ADAMS F,IDDRISSU M,et al.Management of Hydrocephalus with Ventriculoperitoneal Shunts:Review of 109 Cases of Children[J].World Neurosurg,2016,96:129-135.DOI:10.1016/j.wneu.2016.06.111.
[2] GLIEMROTH J,K?SBECK E,KEHLER U.Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus:a retrospective,long-term observational study[J].Clin Neurol Neurosurg,2014,122:92-96.DOI:10.1016/j.clineuro.2014.03.022.
[3] HUSSAIN Z,GHAFFAR A,QASMI S A,et al.Experience of ventriculo-peritoneal shunt insertion in late presenting congenital hydrocephalus[J].J Pak Med Assoc,2016,66(4):57-60.
[4] MIYAJIMA M,KAZUI H,MORI E,et al.One-year outcome in patients with idiopathic normal-pressure hydrocephalus:comparison of lumboperitoneal shunt to ventri-culoperitoneal shunt[J].J Neurosurg,2016,34(5):1-10.
[5] BREIMER G E,HAJI F A,HOVING E W,et al.Development and content validation of performance assessments for endoscopic third ventriculostomy[J].Childs Nerv Syst,2015,31(8):1 247-1 259.DOI:10.1007/s00381-015-2716-4.
[6] HUNG A L,MORAN D,VAKILI S,et al.Predictors of ventriculoperitoneal shunt revision in patients with idiopathic normal pressure hydrocephalus[J].World Neurosurg,2016,90(6):76-81.
[7] SCHUCHT P,BANZ V,TROCHSLER M,et al.Laparoscopically assisted ventriculoperitonealshunt placement:a prospective randomized controlled trial[J].J Neurosurg,2015,122(5):1 058-1 067.
[8] SAEHLE T,FARAHMAND D,EIDE P K,et al.A randomized controlleddual-center trial on shunt complications in idiopathic normal-pressurehydrocephalus treated with gradually reduced or "fixed" pressure valve settings[J].J Neurosurg,2014,121(5):1 257-1 263.
[9] FARAHMAND D,QVARLANDER S,MALM J,et al.Intracranial pressure in hydrocephalus:impact of shunt adjustments and body positions[J].J Neurol Neurosurg Psychiatry,2015,86(2):222-228.
[10] LIU L,ZHANG R,TANG Y,et al.The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension in patients with HIV-associated cryptococcal meningitis with or without hydrocephalus[J].Biosci Trends,2014,8(6):327-332.DOI:10.5582/bst.2014.01070.
[11] YU H,YANG M,ZHAN X,et al.Ventriculoperitoneal shunt placement in poor-grade patients with chronic normal pressure hydrocephalus after aneurysmal subarachnoid haemorrhage[J].Brain Inj,2016,30(1):74-78.DOI:10.3109/02699052.2015.1075153.
[12] SYMSS N P,OI S.Is there an ideal shunt? A panoramic view of 110 years in CSF diversions and shunt systems used for the treatment of hydrocephalus:from historical events to current trends[J].Childs Nerv Syst,2015,31(2):191-202.DOI:10.1007/s00381-014-2608-z.
[13] ZOLAL A,JURATLI T,DENGL M,et al.Daily drained CSF volume is a predictor for shunt dependence-A retrospective study[J].Clin Neurol Neurosurg,2015,138:147-150.DOI:10.1016/j.clineuro.2015.08.021.
[14] MAHANEY K B,CHALOUHI N,VILJOEN S,et al.Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy[J].J Neurosurg,2013,119(4):937-942.DOI:10.3171/2013.5.JNS122494.
[15] 冯书彬,齐林,吕强,等.三脑室底造瘘术和脑室腹腔分流术治疗儿童脑积水疗效分析[J].中国实用神经疾病杂志,2017,20(24):70-74.
[16] MEIER U,STENGEL D,MULLER C,et al.Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus[J].J Neurosurg,2013,73(6):1 054-1 060.
[17] WEIL A G,FALLAH A,CHAMIRAJU P,et al.Endoscopic thirdventriculostomy and choroid plexus cauterization with a rigid neuroendoscope ininfants with hydrocephalus[J].J Neurosurg Pediatr,2016,17(2):163-173.DOI:10.3171/2015.5.PEDS14692.
[18] RIVA-CAMBRIN J,KESTLE J R,HOLUBKOV R,et al.Risk factors for shunt malfunction in pediatric hydrocephalus:a multicenter prospective cohort study[J].J Neurosurg Pedi,2016,17(4):1-9.
[19] EASTWOOD K W,LOOI T,NAGUIB H E,et al.Design optimization ofneuroendoscopic continuum instruments for third ventriculostomy and tumor biopsy[J].Conf Proc IEEE Eng Med Biol Soc,2015,2015:4 853-4 856.DOI:10.1109/EMBC.2015.7319480.
[20] RAJU S,RAMESH S.Endoscopic third ventriculos-tomy through lamina terminalis:Afeasible alternative to standard endoscopic third ventriculostomy[J].Neurol India,2016,64(1):75-80.DOI:10.4103/0028-3886.173655.
[21] ADIB S D,BISDAS S,BORNEMANN A,et al.Neuroendoscopic Trans-ThirdVentricular Approach for Surgical Management of Ecchordosis Physaliphora[J].World Neurosurg,2016,90:701.e1-701.e6.DOI:10.1016/j.wneu.2016.02.041.
[22] DONG G Y,CHUN W U,TING Y U,et al.Clinical analysis of ventriculo-peritoneal shunt in the treatment of patients with normal pressure hydrocephalus[J].J Chin Foreign Med Res,2016,134(5):145-148.
[23] DEMERDASH A,ROCQUE B G,JOHNSTON J,et al.Endoscopic third ventriculostomy:A historical review[J].Br J Neurosurg,2017,31(1):28-32.DOI:10.1080/02688697.2016.1245848.
[24] KLINGE P,HELLSTROM P,TANS J,et al.One-year outcome in the europeanmulticentre study on inph[J].Acta Neurol Scand,2012,126(3):145-153.
[25] CAI Q,ZHANG X,WANG L,et al.Keyhole approach in theneuroendoscopic treatment for hydrocephalus[J].Medicine (Baltimore),2017,96(1):e5823.DOI:10.1097/MD.0000000000005823.
[26] SO T,INOUE M,CHIKAISHI Y,et al.Gefitinib and a ventriculo-peritoneal shunt to manage carcinomatous meningitis from non-small-cell lung cancer:report of two cases[J].Surg Today,2009,39(7):598-602.doi:10.1007/s00595-008-3909-1.
[27] RAY P,JALLO G I,KIM R Y,et al.Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population[J].Neurosurg Focus,2005,19(6):E8.
[28] PENG J,DENG X,HE F,et al.Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus[J].Childs Nerv Syst,2012,28(2):209-215.doi:10.1007/s00381-011-1572-0.
[29] KIM I Y,JUNG S,MOON K S,et al.Neuronavigation-guided endoscopic surgery for pineal tumors with hydrocephalus.[J].J Mini Invasive Neurosurg,2005,47(6):365-368.
[30] KUMAR A,SINGH K,SHARMA V.Surgery in hydrocephalus of tubercular origin:challenges and management[J].Acta Neurochir (Wien),2013,155(5):869-873.doi:10.1007/s00701-013-1658-4.
[31] CELIK A,ERGüN O,ARDA M S,et al.The incidence of inguinal complications after ventriculoperitoneal shunt for hydrocephalus[J].Childs Nerv Syst,2005,21(1):44-47.
[32] VUI H C,LIM W C,LAW H L,et al.Percutaneous endoscopic gastrostomy in patients with ventriculoperitoneal shunt[J].Med J Malaysia,2013,68(5):389-392.
[33] CHUEN-IM P,SMYTH M D,SEGURA B,et al.Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter:a case report[J].Pediatr Pulmonol,2012,47(1):91-95.doi:10.1002/ppul.21510.
[34] KOLIC Z,KUKULJAN M,BONIFACIC D,et al.CSF liver pseudocyst as a complication of a ventriculoperitoneal shunt[J].Wien Klin Wochenschr,2010,122(21/22):641-4.doi:10.1007/s00508-010-1474-2.
[35] MARTíNEZ-LAGE J F,GUILLéN-NAVARRO E,ALMAGRO M J,et al.Hydrocephalus and Chiari type 1 malformation in macrocephaly-cutis marmorata telangiectatica congenita:a case-based update[J].Childs Nerv Syst,2010,26(1):13-18.doi:10.1007/s00381-009-0972-x.
[36] LAI L P,EGNOR M R,CARRION W V,et al.Ventricular peritoneal shunt malfunction after operative correction of scoliosis:report of three cases[J].Spine J,2014,14(11):e5-e8.doi:10.1016/j.spinee.2014.08.448.
[2] GLIEMROTH J,K?SBECK E,KEHLER U.Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus:a retrospective,long-term observational study[J].Clin Neurol Neurosurg,2014,122:92-96.DOI:10.1016/j.clineuro.2014.03.022.
[3] HUSSAIN Z,GHAFFAR A,QASMI S A,et al.Experience of ventriculo-peritoneal shunt insertion in late presenting congenital hydrocephalus[J].J Pak Med Assoc,2016,66(4):57-60.
[4] MIYAJIMA M,KAZUI H,MORI E,et al.One-year outcome in patients with idiopathic normal-pressure hydrocephalus:comparison of lumboperitoneal shunt to ventri-culoperitoneal shunt[J].J Neurosurg,2016,34(5):1-10.
[5] BREIMER G E,HAJI F A,HOVING E W,et al.Development and content validation of performance assessments for endoscopic third ventriculostomy[J].Childs Nerv Syst,2015,31(8):1 247-1 259.DOI:10.1007/s00381-015-2716-4.
[6] HUNG A L,MORAN D,VAKILI S,et al.Predictors of ventriculoperitoneal shunt revision in patients with idiopathic normal pressure hydrocephalus[J].World Neurosurg,2016,90(6):76-81.
[7] SCHUCHT P,BANZ V,TROCHSLER M,et al.Laparoscopically assisted ventriculoperitonealshunt placement:a prospective randomized controlled trial[J].J Neurosurg,2015,122(5):1 058-1 067.
[8] SAEHLE T,FARAHMAND D,EIDE P K,et al.A randomized controlleddual-center trial on shunt complications in idiopathic normal-pressurehydrocephalus treated with gradually reduced or "fixed" pressure valve settings[J].J Neurosurg,2014,121(5):1 257-1 263.
[9] FARAHMAND D,QVARLANDER S,MALM J,et al.Intracranial pressure in hydrocephalus:impact of shunt adjustments and body positions[J].J Neurol Neurosurg Psychiatry,2015,86(2):222-228.
[10] LIU L,ZHANG R,TANG Y,et al.The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension in patients with HIV-associated cryptococcal meningitis with or without hydrocephalus[J].Biosci Trends,2014,8(6):327-332.DOI:10.5582/bst.2014.01070.
[11] YU H,YANG M,ZHAN X,et al.Ventriculoperitoneal shunt placement in poor-grade patients with chronic normal pressure hydrocephalus after aneurysmal subarachnoid haemorrhage[J].Brain Inj,2016,30(1):74-78.DOI:10.3109/02699052.2015.1075153.
[12] SYMSS N P,OI S.Is there an ideal shunt? A panoramic view of 110 years in CSF diversions and shunt systems used for the treatment of hydrocephalus:from historical events to current trends[J].Childs Nerv Syst,2015,31(2):191-202.DOI:10.1007/s00381-014-2608-z.
[13] ZOLAL A,JURATLI T,DENGL M,et al.Daily drained CSF volume is a predictor for shunt dependence-A retrospective study[J].Clin Neurol Neurosurg,2015,138:147-150.DOI:10.1016/j.clineuro.2015.08.021.
[14] MAHANEY K B,CHALOUHI N,VILJOEN S,et al.Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy[J].J Neurosurg,2013,119(4):937-942.DOI:10.3171/2013.5.JNS122494.
[15] 冯书彬,齐林,吕强,等.三脑室底造瘘术和脑室腹腔分流术治疗儿童脑积水疗效分析[J].中国实用神经疾病杂志,2017,20(24):70-74.
[16] MEIER U,STENGEL D,MULLER C,et al.Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus[J].J Neurosurg,2013,73(6):1 054-1 060.
[17] WEIL A G,FALLAH A,CHAMIRAJU P,et al.Endoscopic thirdventriculostomy and choroid plexus cauterization with a rigid neuroendoscope ininfants with hydrocephalus[J].J Neurosurg Pediatr,2016,17(2):163-173.DOI:10.3171/2015.5.PEDS14692.
[18] RIVA-CAMBRIN J,KESTLE J R,HOLUBKOV R,et al.Risk factors for shunt malfunction in pediatric hydrocephalus:a multicenter prospective cohort study[J].J Neurosurg Pedi,2016,17(4):1-9.
[19] EASTWOOD K W,LOOI T,NAGUIB H E,et al.Design optimization ofneuroendoscopic continuum instruments for third ventriculostomy and tumor biopsy[J].Conf Proc IEEE Eng Med Biol Soc,2015,2015:4 853-4 856.DOI:10.1109/EMBC.2015.7319480.
[20] RAJU S,RAMESH S.Endoscopic third ventriculos-tomy through lamina terminalis:Afeasible alternative to standard endoscopic third ventriculostomy[J].Neurol India,2016,64(1):75-80.DOI:10.4103/0028-3886.173655.
[21] ADIB S D,BISDAS S,BORNEMANN A,et al.Neuroendoscopic Trans-ThirdVentricular Approach for Surgical Management of Ecchordosis Physaliphora[J].World Neurosurg,2016,90:701.e1-701.e6.DOI:10.1016/j.wneu.2016.02.041.
[22] DONG G Y,CHUN W U,TING Y U,et al.Clinical analysis of ventriculo-peritoneal shunt in the treatment of patients with normal pressure hydrocephalus[J].J Chin Foreign Med Res,2016,134(5):145-148.
[23] DEMERDASH A,ROCQUE B G,JOHNSTON J,et al.Endoscopic third ventriculostomy:A historical review[J].Br J Neurosurg,2017,31(1):28-32.DOI:10.1080/02688697.2016.1245848.
[24] KLINGE P,HELLSTROM P,TANS J,et al.One-year outcome in the europeanmulticentre study on inph[J].Acta Neurol Scand,2012,126(3):145-153.
[25] CAI Q,ZHANG X,WANG L,et al.Keyhole approach in theneuroendoscopic treatment for hydrocephalus[J].Medicine (Baltimore),2017,96(1):e5823.DOI:10.1097/MD.0000000000005823.
[26] SO T,INOUE M,CHIKAISHI Y,et al.Gefitinib and a ventriculo-peritoneal shunt to manage carcinomatous meningitis from non-small-cell lung cancer:report of two cases[J].Surg Today,2009,39(7):598-602.doi:10.1007/s00595-008-3909-1.
[27] RAY P,JALLO G I,KIM R Y,et al.Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population[J].Neurosurg Focus,2005,19(6):E8.
[28] PENG J,DENG X,HE F,et al.Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus[J].Childs Nerv Syst,2012,28(2):209-215.doi:10.1007/s00381-011-1572-0.
[29] KIM I Y,JUNG S,MOON K S,et al.Neuronavigation-guided endoscopic surgery for pineal tumors with hydrocephalus.[J].J Mini Invasive Neurosurg,2005,47(6):365-368.
[30] KUMAR A,SINGH K,SHARMA V.Surgery in hydrocephalus of tubercular origin:challenges and management[J].Acta Neurochir (Wien),2013,155(5):869-873.doi:10.1007/s00701-013-1658-4.
[31] CELIK A,ERGüN O,ARDA M S,et al.The incidence of inguinal complications after ventriculoperitoneal shunt for hydrocephalus[J].Childs Nerv Syst,2005,21(1):44-47.
[32] VUI H C,LIM W C,LAW H L,et al.Percutaneous endoscopic gastrostomy in patients with ventriculoperitoneal shunt[J].Med J Malaysia,2013,68(5):389-392.
[33] CHUEN-IM P,SMYTH M D,SEGURA B,et al.Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter:a case report[J].Pediatr Pulmonol,2012,47(1):91-95.doi:10.1002/ppul.21510.
[34] KOLIC Z,KUKULJAN M,BONIFACIC D,et al.CSF liver pseudocyst as a complication of a ventriculoperitoneal shunt[J].Wien Klin Wochenschr,2010,122(21/22):641-4.doi:10.1007/s00508-010-1474-2.
[35] MARTíNEZ-LAGE J F,GUILLéN-NAVARRO E,ALMAGRO M J,et al.Hydrocephalus and Chiari type 1 malformation in macrocephaly-cutis marmorata telangiectatica congenita:a case-based update[J].Childs Nerv Syst,2010,26(1):13-18.doi:10.1007/s00381-009-0972-x.
[36] LAI L P,EGNOR M R,CARRION W V,et al.Ventricular peritoneal shunt malfunction after operative correction of scoliosis:report of three cases[J].Spine J,2014,14(11):e5-e8.doi:10.1016/j.spinee.2014.08.448.