腰大池–腹腔分流术治疗脑血管病继发慢性脑积水的安全性及有效性分析

Analysis of the Safety and Efficacy of Lumbar-Peritoneal Shunt in the Treatment of Chronic Hydrocephalus Secondary to Cerebrovascular Disease

摘要: 目的：评估腰大池–腹腔分流术(LPS)治疗脑血管病(CVD)继发慢性脑积水的安全性及有效性。方法：回顾性分析我科2020年4月~2022年4月因慢性脑积水行腰大池–腹腔分流术(LPS)的病例资料，筛选原发病为CVD继发的出血性脑卒中病例。汇总并分析术后症状改善、并发症情况及随访结果。结果：共31例病人，动脉瘤破裂性蛛网膜下腔出血(aSAH) 21例、烟雾病(MMD)及烟雾综合征(MMS) 6例、脑血管畸形4例。术前昏迷3例，余28例症状主要包括步态不稳、小便失禁、记忆力减退及进行性痴呆。7例围手术期未停用抗血小板药物。随访3个月~2年，截止随访结束：3例昏迷者2例意识清醒，1例昏睡；余28例步态不稳、小便失禁及进行性痴呆、记忆力减退症状均消失。2例术后1周内出现分流管脱出腹腔，给予重新探查置管。无颅内出血及感染、癫痫等并发症。结论：LPS对CVD继发慢性脑积水的治疗安全有效，尤其适用于CVD中脑室–腹腔分流手术风险高的特殊病例。

Abstract: Objective: To evaluate the safety and effectiveness of lumbar-peritoneal shunt (LPS) in the treat-ment of chronic hydrocephalus secondary to cerebrovascular disease (CVD). Methods: The clinical data of lumbar-peritoneal shunt (LPS) for chronic hydrocephalus in our department from April 2020 to April 2022 were retrospectively analyzed, cases of hemorrhagic stroke secondary to CVD as the primary disease were screened out. Clinical data including symptom improvement, complica-tions and follow-up results were summarized and analyzed. Results: A total of 31 patients were in-cluded: 21 cases of aneurismal subarachnoid hemorrhage (aSAH), 6 cases of moyamoya disease (MMD) and moyamoya syndrome (MMS), and 4 cases of cerebrovascular malformation. Preoperative coma was observed in 3 cases, and symptoms of the rest 28 cases mainly included gait instability, urinary incontinence, memory loss and progressive dementia. In 7 cases, antiplatelet drugs were not discontinued during the perioperative period. The follow-up period was 3 months to 2 years, at the end of the follow-up: among the 3 coma patients, 2 were conscious and 1 was lethargic, and symptoms of gait instability, urinary incontinence, progressive dementia and memory loss disap-peared in the rest 28 cases. In 2 cases, the shunt was dislodged from the abdominal cavity within 1 week after surgery, then surgery of abdominal cavity exploration and shunt reposition was per-formed. No intracranial hemorrhage, infection, epilepsy and other complications occurred. Conclu-sion: LPS is safe and effective in the treatment of chronic hydrocephalus secondary to CVD, and is especially suitable for special cases with high risk of ventriculoperitoneal shunt surgery in CVD.