陈国昌 石小峰 欧阳锡华 周路球

【摘要】 目的：探讨同期脑室-腹腔分流术及颅骨修补术在去骨板减压术后癫痫治疗中的效果。方法：回顾性分析2013年1月-2017年12月本院收治的颅脑损伤行去骨瓣减压术后发生癫痫及脑积水患者16例的临床资料。患者均行脑室-腹腔分流及颅骨修补术，比较患者手术前后的脑电图情况及神经功能（FIM评分）。结果：去骨瓣减压术后平均（60.2±16.6）d行脑室-腹腔分流及颅骨修补术；患者术后重度及中重度异常、中度异常患者例数均少于术前，轻度异常患者例数多于术前，比较差异均有统计学意义（P<0.05），且患者术后13例（81.25%）异常EEG得到改善，3例（18.75%）变化不大；患者术前FIM评分低于术后评分（P<0.05），且14例患者术后FIM评分均高于术前。结论：去骨瓣减压术后癫痫合并脑积水的患者同期行脑室-腹腔分流术和颅骨修补术，可以促进脑电图及神经功能恢复，降低癫痫发生率，改善预后。

【关键词】 癫痫； 颅骨缺损； 脑室-腹腔分流术； 颅骨修补术

【Abstract】 Objective：To investigate the effect of simultaneous ventriculoperitoneal shunt and cranioplasty in the treatment of epilepsy after decompression of bone flap.Method：The clinical data of 16 craniocerebral injury patients with epilepsy and hydrocephalus after decompression of bone flap from Jan 2013 to Dec 2017 were retrospectively analyzed.They underwent ventriculoperitoneal shunt and cranioplasty，the electroencephalogramand neurological function（FIM score） before and after operation were compared.Result：The ventriculoperitoneal shunt and cranioplasty were performed on average（60.2±16.6） d after decompressive craniectomy.The number of patients with severe and moderate or moderate abnormality after operation were less than those of before operation，the number of patients with mild abnormality was more than that of before operation，the difference was statistically significant（P<0.05），and 13 cases（81.25%） after operation were improved，and 3 cases（18.75%） had little change.The FIM score before operation was lower than that of after operation（P<0.05），and the FIM scores in 14 patients were all higher than those of before operation.Conclusion：The patients with epilepsy complicated with hydrocephalus after bone flap decompression are treated with simultaneous ventriculoperitoneal shunt and cranioplasty at the same time，can promote the recovery of EEG and nerve function，reduce the incidence of epilepsy and improve the prognosis.

【Key words】 Epilepsy； Cranial defect； Ventriculoperitoneal shunt； Cranioplasty

First-authors address：Shenzhen Longgang Central Hospital，Shenzhen 518016，China

doi：10.3969/j.issn.1674-4985.2018.24.031

本研究選取颅骨缺损并癫痫及脑积水患者16例开展研究，探讨临床采用同期行脑室-腹腔分流术及颅骨修补术治疗的可行性，现报道如下。

1 资料与方法

1.1 一般资料回顾性分析2013年1月-2017年12月本院收治的颅脑损伤行去骨瓣减压术后发生癫痫及脑积水患者16例的临床资料。纳入标准：年龄18～65岁；既往头部外伤史；入院时急诊行开颅手术，术后出现脑积水及癫痫发作；入院后格拉斯哥昏迷评分法（GCS）6～15分；术后头颅CT平扫显示为脑积水及颅骨缺损病灶；无严重基础脏器疾病，如心肺疾病及肝肾脏功能不全等。排除标准：已孕、已育女性患者；资料不完整者。其中男11例，女5例；年龄31～60岁，平均（40.0±1.5）岁；入院时GCS评分6～8分6例，9～12分9例，13～15分1例；入院头颅CT检查示：脑挫裂伤伴硬膜下血肿10例，巨大硬膜外血肿3例，弥漫性脑肿胀3例。该研究经伦理委员会批准，患者及家属知情同意。……