用脑室-腹腔分流及颅骨修补术治疗脑外伤并发脑积水伴颅骨缺损的时机分析湖北老河口市第一医院，神经外科，邮编湖北441800摘要：目的：观察分析采用脑室■腹腔分流术及颅骨修补术治疗脑外伤并发脑积水伴颅骨缺损的适宜时机。方法：回顾分析2013年1月至2016年1月期间，我院收治的58例脑外伤并发脑积水伴颅骨缺损患者的住院资料，计算机随机将其分为两组。其中研究组患者29例，釆用早期同期脑室■腹腔分流及颅骨修补术治疗；对照组患者29例，方法为分期治疗，即实施脑室•腹腔分流术后3~6月，再进行颅骨修补术。追踪随访患者的临床疗效，对患者行格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)并记录，观察统计两组患者术后并发症发生情况。结果：所有患者实施手术治疗后，相较于术前，患者的GCS和GOS评分均得到显著改善，但研究组患者术后恢复良好数要明显高于对照组，差异表现出统计学意义(P<0.05)o研究组患者术后并发症发生总数为7例，对照组患者为17例，两组间存在显著性差异，尤其表现在分流过度和硬膜下积液、血肿两方面，而其他如切口感染、切口脑脊液渗漏和脑水肿等项目上两组间差异无统计学意义(P>0.05)o结论：早期同期应用脑室■腹腔分流术和颅骨修补术治疗脑外伤并发脑积水伴颅骨缺损相较于早期分期应用而言，具有更佳的临床效果，且并发症发生率低，是该手术的较适宜时期，值得在临床上实施推广。关键词：脑室■腹腔分流；脑外伤；颅骨修补术；颅骨缺损【中图分类号】R246【文献标识码】A【文章编号】1001-5213(2016)08-0253-02Abstract:objective:toobservetheanalysisoftheventricles・celiacbypassandskullbraintraumarepairtreatmentofhydrocephaluswithskulldefectsuitableopportunity.Methods:retrospectiveanalysisinJanuary2013toJanuary2016,ourhospitalof58casesofbraininjurycomplicatedwithhydrocephaluspatientswithskulldefectwithhospitalinformation,thecomputerrandomdividedintotwogroups.29patientswiththeteam,usingtheearlyperiodofventricleperitonealshuntandskullrepairtreatment;29patientswiththecontrolgroup,themethodforthetreatmentinstages,namelytheimplementat:ionoftheventricle-3~6monthspostoperatively,three-junctionplacementforsurgicalrepairoftheskull.Follow-upofpatientswithaclinicalcurativeeffectofparentswithaGlasgowcomascale(GCS),Glasgowoutcomescore(GOS)andrecords,observationstatisticsoftwogroupsofpatientswithpostoperativecomplications.Results:allpatientsaftertreatmentwithsurgery,comparedwithbeforeoperation,thepatientswithGCSandGOSscoreswereimprovedsignificantly,buttheteamrecoveredwellpostoperativelyinpatientswithsignificantlyhigherthanthatofcontrolgroup,showingstatisticallysignificantdifference(P<0.05).Teaminpatientswithpostoperativecomplicationsoccurredin7cases,totalof17patientswiththecontrolgroup,sign讦icantdifferencesbetweenthetwogroups,especiallyinshuntexcessiveandtwoaspectsofsubduraleffusion,hematoma,others,suchasincisioninfection,leakageofcerebrospinalfluidandbrainedemaofincisiononprojectssuchastherewasnostatisticallysignificantdiffereneebetweenthetwogroups(P>0.05).Conclusion:earlyapplicationperiodventricle-celiacbypassandskullbraintraumarepairtreatmentofhydrocephaluswithskulldefectcomparedwiththeearlystagesofapplications,hasabetterclinicaleffect,andlowincidenceofcomplications,isamoresuitableperiodofthesurgery,isworthpopularizinginclinicalimplementation.Keywords:ventricleperitonealshunt;Braininjury;Surgicalrepairofskull;Skulldefect脑外伤大多因直接或间接暴力导致脑组织器质性缺损，多并发脑积水伴颅骨缺损，从而加重患者病情，若救治不及吋或治疗不当，易造成患者残疾或死亡⑴。对于脑外伤并发脑积水伴颅骨缺损的临床治疗方案，以往多采用早期分期法，即先给以脑室■腹腔分流术治疗，3~6月后再行颅骨...