早期脑室分流及颅骨修补治疗颅脑外伤术后脑积水

　　【摘要】 目的 探讨早期一次性脑室腹腔分流及颅骨修补在颅脑外伤术后脑积水治疗中的作用。方法 回顾性分析45例早期同期行脑室腹腔分流及颅骨修补手术的颅脑外伤病例，对其临床资料、并发症及其预后进行总结。结果 本组手术时间均在伤后3个月内进行，术后并发分流管阻塞2例(4.4%)，颅内感染2例(4.4%);术后意识及神经功能障碍不同程度的改善40例(88.9%);恢复良好24例(53.3%)，中度残疾11例(24.4%)，无手术死亡病例。结论 颅脑损伤术后颅骨缺损、脑积水、脑膨出严重影响患者预后，早期同期行脑室腹腔分流及颅骨修补手术并发症少，可明显改善患者意识及神经功能障碍，改善患者预后，值得推广。

　　【关键词】 颅脑损伤 脑室腹腔分流术 颅骨修补术 脑积水

　　Early ventriculo-peritoneal shunt and cranioplasty for the postoperative

　　hydrocephalus in traumatic brain injury

　　WAN Qing, CUI Yitian, SONG Yang, CAI Tingjiang, JIANG Xiaowei

　　(Department of Neurosurgery， the 97th Hospital of PLA， Xuzhou， Jiangsu 221004， China)

　　Abstract:Objective To evaluate the early one-stage ventriculoperitoneal shunt and cranioplasty for treating traumatic brain injury with hydrocephalus and skull defect.Methods Retrospect study was made on 45 patients who were found to have hydrocephalus after the surgical intervention of the traumatic brain injury complicated by skull defect.Results Early one-stage operation of ventriculo-peritoneal shunt and cranioplasty was performed within 3 months after trauma. The clinical complications of the operation included block of the shunt tube (2 cases, 4.4%)and skull infection (2 cases, 4.4%). 40 patients (88.9%)got improved with consciousness and nerve function, including 24 cases of good recovery and 11 cases of moderate deficit. There was no operative mortality.Conclusion The complications of skull defect， brain swelling and hydrocephalus after traumatic brain injury operation will seriously threat the patient′s prognosis. Early one-stage ventriculo-peritoneal shunt and cranioplasty, causing few complications, can improve patients′consciousness, nerve function and outcome, and hence, is worthy of recommendation.

　　Key words: craniocerebral trauma; cerebral ventriculo-peritoneal shunt; cranioplasty; hydrocephalus

　　重型颅脑外伤患者早期行开颅手术清除血肿及碎裂脑组织并去除骨瓣是缓解颅内压及降低死亡率的重要方法，但术后此类患者脑积水、脑膨出常有发生，严重影响患者的预后[1]。传统的方法

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