内镜下第三脑室造瘘术治疗梗阻性脑积水的早期手术结果：一项随机对照试验
Early Surgical Outcome of Endoscopic Third Ventriculostomy in the Management of Obstructive Hydrocephalus: A Randomized Control Trial.
作者信息
Rahman Mohammad Mahfuzur, Salam Mohammad Abdus, Uddin Kalim, Rahman Mohammad Mizanur, Islam Mohammad Rafiqul, Haque Mohammad Ashraful, Hussain Ahmed Riyad, Yusuf Mohammad Abdullah
机构信息
Department of Neurotrauma Surgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
Department of Orthopedics, Gofargaon Upazila Health Complex, Mymensingh, Bangladesh.
出版信息
Asian J Neurosurg. 2018 Oct-Dec;13(4):1001-1004. doi: 10.4103/ajns.AJNS_376_16.
BACKGROUND
Management of obstructive hydrocephalus is an important issue for the reduction of mortality and morbidity.
OBJECTIVES
The aim of the present study was to assess the early surgical outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus.
METHODOLOGY
This randomized controlled trial was conducted at the Department of Neurosurgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from April 2009 to September 2010 for 1½ years. All patients presenting with obstructive hydrocephalus with the obstruction at or distal to the third ventricle and age 6 months and above were included in the study population. All the patients were divided into two groups named as Group A (experimental group) who were treated with ETV and Group B (control group) who were treated with ventriculoperitoneal shunt (VPS). The early surgical outcome was defined as outcomes within 1 month following surgical interventions. Pre- and post-operative outcomes of this study were measured.
RESULTS
A total number of sixty patients were recruited from which thirty patients were in Group A and the rest thirty patients were in Group B. The mean postoperative head circumference was 43.4 ± 7.1 cm and 47.8 ± 5.6 cm in VPS and ETV surgery, respectively ( ≤ 0.01). Postoperative vomiting was improved 24 (92.3%) in Group A and 23 (88.5%) in Group B ( < 0.05). Postoperative infection occurred in 1 (3.3%) case in Group A and 8 (26.7%) cases in Group B ( < 0.05). The success of the operation in Group A and Group B included 25 (83.3%) cases and 12 (40%) cases, respectively ( < 0.05).
CONCLUSION
Early surgical outcome following ETV is better than VPS surgery in patients with obstructive hydrocephalus.
背景
梗阻性脑积水的治疗是降低死亡率和发病率的重要问题。
目的
本研究旨在评估内镜下第三脑室造瘘术（ETV）治疗梗阻性脑积水的早期手术效果。
方法
本随机对照试验于2009年4月至2010年9月在孟加拉国达卡的班加班杜·谢赫·穆吉布医科大学神经外科进行，为期1年半。所有梗阻性脑积水患者，梗阻部位在第三脑室或其远端，年龄6个月及以上，均纳入研究人群。所有患者分为两组，A组（实验组）接受ETV治疗，B组（对照组）接受脑室腹腔分流术（VPS）治疗。早期手术效果定义为手术干预后1个月内的结果。测量本研究的术前和术后结果。
结果
共招募60例患者，其中A组30例，其余30例在B组。VPS手术和ETV手术术后平均头围分别为43.4±7.1 cm和47.8±5.6 cm（P≤0.01）。A组术后呕吐改善24例（92.3%），B组23例（88.5%）（P<0.05）。A组术后感染1例（3.3%），B组8例（26.7%）（P<0.05）。A组和B组手术成功分别为25例（83.3%）和12例（40%）（P<0.05）。
结论
梗阻性脑积水患者ETV术后早期手术效果优于VPS手术。
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