不同穿刺路径对继发交通性脑积水的临床疗效分析

目的探讨经侧脑室额角穿刺和经侧脑室枕角穿刺在继发交通性脑积水中的临床疗效。方法回顾性分析 2020年7月—2022年12月中国科学技术大学附属第一医院收治的231例继发交通性脑积水患者，按照手术入路的不同分为经额角穿刺组和经枕角穿刺组，其中经额角穿刺组128例，经枕角组103例。通过比较两组术后分流管的位置、疗效、并发症，判断二者的优缺点。结果纳入的231例患者中，继发性脑积水总体感染率和术后脑出血率分别为6.93%和2.60%；与经枕角穿刺组对比，经额角穿刺组引流管的总体置管位置更佳，感染率更低（P<0.05）,而二者在术后堵管率、疗效及预后上无明显差异（P>0.05）。结论在继发性交通性脑积水中，经额角穿刺操作简单，并发症较少，建议优先选用经额穿刺入路穿刺行腹腔分流术。

Objective To explore the clinical efficacy of lateral ventricles frontal puncture and lateral ventricles occipital puncture in secondary communicating hydrocephalus. Methods The clinical data of 231 patients with secondary communicating hydrocephalus admitted to the First Affiliated Hospital of the University of Science and Technology of China from July 2020 to December 2022 were analyzed retrospectively. They were divided into two groups according to different surgical approaches in ventriculoperitoneal shunt(VPS), the frontal horn puncture group(128 cases) and the occipital horn puncture group(103 cases). A comparison of the position, therapeutic effect, and complications of the shunt tube after surgery between the two group was drawn to determine their respective advantages and disadvantages. Results Among the 231 cases included, the overall infection rate of secondary hydrocephalus and postoperative cerebral hemorrhage rate were 6.93% and 2.60%, respectively. Compared with the occipital horn puncture group, the frontal horn puncture group has better overall placement of drainage tubes and lower infection rate(P<0.05), while there was no significant difference in postoperative blockage rate, therapeutic effect and prognosis between the two groups(P>0.05). Conclusions In secondary communicating hydrocephalus, frontal horn puncture is a simple procedure with fewer complications. It is recommended to prioritize the frontal horn puncture for VPS.