脑室腹腔分流术在新型隐球菌脑膜炎中的应用

Application of ventriculoperitoneal shunt in Cryptococcus neoformans meningitis

摘要:

目的 分析脑室腹腔分流术（Ventriculoperitoneal Shunt，VPS）对伴有明显颅内高压新型隐球菌性脑膜炎的治疗效果。方法 回顾性收集2014年1月-2016年11月中山大学附属第三医院22例确诊为新型隐球菌性脑膜炎并伴有明显颅内高压接受VPS的患者，通过分析比较VPS术前后颅内压力、主要临床症状、手术后并发症发生情况，评价VPS对伴有明显颅内高压新型隐球菌性脑膜炎的治疗效果。结果 22例患者术后脑脊液压力明显下降（P < 0.001）；患者主要症状如意识障碍、头痛、视力、听力障碍等明显好转。手术后并发症少，无隐球菌感染扩散现象发生，有少量导管相关并发症，与其他脑积水行VPS者无明显差异。结论 VPS可以有效降低颅内高压，改善临床症状，手术不良反应少。

Abstract:

Objective To investigate the effect of ventriculoperitoneal shunt (VPS) in the treatment of patients with Cryptococcus neoformans meningitis complicated by marked intracranial hypertension.Methods A retrospective analysis was performed for the clinical data of 22 patients who were diagnosed with Cryptococcus neoformans meningitis complicated by marked intracranial hypertension and underwent VPS in The Third Affiliated Hospital of Sun Yat-Sen University from January 2014 to November 2016. Intracranial pressure before and after VPS, major clinical symptoms, and postoperative complications were analyzed and compared to evaluate the effect of VPS in the treatment of Cryptococcus neoformans meningitis complicated by marked intracranial hypertension.Results Of all patients, 22 achieved a significant reduction in cerebrospinal fluid pressure after surgery (P<0.001), and there were significant improvements in major symptoms such as disturbance of consciousness, headache, visual impairment, and hearing disorder. There were few postoperative complications and no spread of Cryptococcus neoformans infection. There were no significant differences in catheter-related complications between these patients and the patients who underwent VPS due to hydrocephalus.Conclusions VPS can effectively reduce intracranial hypertension and improve clinical symptoms and has few adverse events.