长程脑室外引流术治疗结核性脑膜炎合并脑积水的临床效果

目的:探讨皮下隧道长程脑室外引流术(long tunnelled external ventricular drainage, LTEVD)对结核性脑膜炎合并脑积水的治疗效果。方法:收集2018年1月至2021年5月深圳市第三人民医院神经外科应用脑室外引流术治疗的结核性脑膜炎合并脑积水的43例患者临床资料，其中，26例采用传统脑室外引流术(EVD)治疗(传统EVD组),17例采用LTEVD治疗(LTEVD组)。比较两组患者治疗效果和并发症情况。结果:17例LTEVD组患者引流时间为16～67 d,平均(28.12±13.86) d;其中，5例(29.4%)拔管后脑积水加重，行二期脑室腹腔分流术。26例传统EVD组患者单次引流时间均未超过14 d;其中，16例(61.5%)拔管后脑积水复发，行二期脑室腹腔分流术。LTEVD组患者住院时间30.00(24.00,33.50) d]与传统EVD组30.50(26.00,39.25) d]差异无统计学意义(Z=0.847,P=0.397),但引流期间LTEVD组患者脱管频率和脑脊液漏发生率及颅内感染发生率均为0.0%(0/17)]、置管频...

Clinical effect on the treatment of long tunnelled external ventricular drainage for tuberculous meningitis complicated with hydrocephalus

Objective: To investigate the effect of long tunnelled external ventricular drainage (LTEVD) for tuberculous meningitis complicated with hydrocephalus. Methods: The clinical data of 43 tuberculous meningitis patients with hydrocephalus were retrospectively collected. All of them were treated with external ventricular drainage (EVD) in the Department of Neurosurgery, The Third People’s Hospital of Shenzhen from January 2018 to May 2021. Of them, 26 were treated with traditional EVD (traditional EVD group) and 17 were treated with LTEVD (LTEVD group). The therapeutic effect and complications were compared between the two groups. Results: Seventeen patients’s drainage time was 16-67 days in the LTEVD group, with an average of (28.12±13.86) days. Among them, 5 patients (29.4%) had aggravated hydrocephalus after the removal of the long-distance external drainage tube and was treated with ventriculoperitoneal shunt surgery. The 26 patients’s single drainage time did not exceed 14 days in the traditional EVD group. Among them, 16 patients (61.5%) had recurrence of hydrocephalus after extubation and then underwent ventriculoperitoneal shunt surgery. The hospital stay of patients in LTEVD group was 30.00 (33.50, 24.00) d, which was lower than that in traditional EVD group (30.50 (39.25, 26.00) d), the difference was not statistically significant (Z=0.847, P=0.397). However, the rate of unexpected extubation, cerebrospinal fluid leakage and intracranial infection, the incidences of catheterization and secondary shunt surgery in LTEVD group were all significantly lower or less than those in traditional EVD group (0.0% (0/17) vs. 30.8% (8/26), χ²=6.426, P=0.014; 0.0% (0/17) vs. 30.8% (8/26), χ²=6.426, P=0.014; 0.0% (0/17) vs. 26.9% (7/26), χ²=5.467, P=0.031; 100.0% (17/17) vs. 180.8% (47/26), χ²=5.932, P=0.000; 29.4% (5/17) vs. 61.5% (16/26), χ²=4.246, P=0.039; respectively). Patients in both groups were followed up for 1-2 years after discharge. The total effective rate was 82.4% (14/17) in LTEVD group, and was 69.2% (18/26) in the traditional EVD group, there was no significant difference between the two groups (χ²=0.368, P=0.544). Conclusion: LTEVD is a safe and effective technology for tuberculous hydrocephalus, which with longer drainage time and fewer complications compared to the traditional EVD.