关键词: 结核, 脑膜/并发症, 脑积水, 脑室腹膜分流术, 可行性研究

Abstract: Objective To explore the clinical feasibility on treatment of patients with tuberculous hydroce-phalus by using early ventriculo peritoneal shunt. Methods A retrospective analysis was conducted. Thirty patients with tuberculous meningitis hydrocephalus who received ventriculo-peritoneal shunt treatment in the 309th Hospital of PLA from 2006 January to 2010 December were included in this study. The enrolled patients were divided into two groups according to whether the intracranial tuberculosis (TB) was controlled or not, namely early (9) or late (21) ventricle-peritoneal shunt group. The following data or information related to the patients were recorded and analyzed: Palur grade, GCS score, postoperative shunt patency and ADL grade. Results All the 9 patients in the early ventriculo-peritoneal shunt group were classified as Palur Grade Ⅲ or Ⅳ, and 7/9 cases had GCS score less than 8 points. Four out of 21 patients in the late group were classified as Palur Grade Ⅲ or Ⅳ, and 1/21 cases had GCS score less than 8 points. One patient in each group occurred shunt tube obstruction after the surgery which resulted in failure of ventriculo-peritoneal shunt treatment and tube drawing. At the end of 12 months after discharged from the hospital, the results of ADL Grade among all patients were as follows: 10 cases (33.33%) were ADL Grade Ⅰ, 5 cases (16.67%) were ADL Grade Ⅱ, 6 cases (20.00%) were ADL Grade Ⅲ, 6 cases (20.00%) were ADL Grade Ⅳ and 3 (10.00%) cases were ADL Grade Ⅴ. Meanwhile, 7/9 patients in the early group reached ADL Grade Ⅰ-Ⅲ while 14/21 patients in the late group reached ADL Grade Ⅰ-Ⅲ. Conclusion This study found that it is feasible to treat the patients with tuberculous hydrocephalus by using early ventriculo-peritoneal shunt when TB in brain has not been cured. The results suggested that regardless of whether the intracranial TB has been controlled or not, early ventriculo-peritoneal shunt did not result in the increased risk of intracranial infection and CSF protein blocking.

Key words: Tuberculosis, meningeal/complications, Hydrocephalus, Ventriculoperitoneal shunt, Feasibility studies