丘脑后出血性脑积水的治疗：脑室-腹腔分流术还是内镜第三脑室造瘘术？一项回顾性观察研究。
Treatment of post-thalamic hemorrhage hydrocephalus: ventriculoperitoneal shunt or endoscopic third ventriculostomy? A retrospective observational study.
机构信息
Clinical Medicine School of Ningxia Medical University, Ningxia Hui Autonomous Region, Yinchuan, China.
Departmen of Neurosurgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China.
出版信息
BMC Neurol. 2024 Sep 28;24(1):365. doi: 10.1186/s12883-024-03880-0.
BACKGROUND
The aim of this study was to compare the efficacy of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus after thalamic hemorrhage (TH) where external ventricular drainage (EVD) could not be removed after hematoma absorption, and to provide a theoretical basis for the clinical treatment of hydrocephalus after TH.
METHODS
The clinical data of patients with hydrocephalus after TH whose EVD could not be removed after hematoma absorption were retrospectively analyzed. According to the patients' surgical methods, the patients were divided into the VPS group and ETV group. The operative time, length of hospital stay, complications, and reoperation rates of the two groups were compared.
RESULTS
There was no statistically significant difference in intraoperative bleeding, length of hospital stay between the two groups. The EVD tubes were successfully removed in all patients after surgery. There were 4 (9.5%) complications in the ETV group and 3 (6.7%) complications in the VPS group, with no statistically significant difference in postoperative complications between the two groups. During the 1-year follow-up, 7 patients (16.7%) in the ETV group and 3 patients (6.7%) in the VPS group required reoperation. In the subgroup analysis of TH combined with fourth ventricular hemorrhage, 6 patients (14.3%) in the ETV group and 1 patient (2.2%) in the VPS group required reoperation, and the difference between the two groups was statistically significant.
CONCLUSIONS
ETV had good efficacy in treating hydrocephalus caused by TH and TH that broke into the lateral ventricle and the third ventricle. However, if hydrocephalus was caused by TH with the fourth ventricular hematoma, VPS was a better surgical method because the recurrence rate of hydrocephalus in ETV was higher than that in VPS. Therefore, the choice of surgical method should be based on the patient's clinical features and hematoma location.
背景
本研究旨在比较脑室-腹腔分流术（VPS）和内镜第三脑室造瘘术（ETV）治疗丘脑血肿（TH）后血肿吸收后无法拔除外引流管（EVD）所致脑积水的疗效，为 TH 后脑积水的临床治疗提供理论依据。
方法
回顾性分析 TH 后血肿吸收后无法拔除 EVD 的脑积水患者的临床资料。根据患者的手术方法，将患者分为 VPS 组和 ETV 组。比较两组患者的手术时间、住院时间、并发症及再手术率。
结果
两组术中出血量、住院时间比较，差异无统计学意义。术后所有患者 EVD 管均顺利拔除。ETV 组有 4 例（9.5%）并发症，VPS 组有 3 例（6.7%）并发症，两组术后并发症比较，差异无统计学意义。随访 1 年，ETV 组有 7 例（16.7%）、VPS 组有 3 例（6.7%）需再次手术。在 TH 合并第四脑室出血的亚组分析中，ETV 组有 6 例（14.3%）、VPS 组有 1 例（2.2%）需再次手术，两组比较，差异有统计学意义。
结论
ETV 治疗 TH 及破入侧脑室和第三脑室的脑积水效果良好，但对于 TH 合并第四脑室血肿所致脑积水，VPS 是更好的手术方法，因为 ETV 组脑积水的复发率高于 VPS 组。因此，手术方法的选择应根据患者的临床特征和血肿位置而定。
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