小脑扁桃体软膜切除术与硬膜扩大修补术临床对照分析
董先成 陈 忠 邹坤良 邓功建 郎 清
达州市中心医院，四川 达州 635000
通信作者：陈忠
【摘要】 目的 分析小脑扁桃体软膜切除术与硬膜扩大修补术对小脑扁桃体下疝畸形（ChiariⅠ型畸形）患者临床症状、脑脊液流体动力学及预后的影响。方法 选取017-01—2020-01 达州市中心医院收治的经 MRI 确诊的 95 例 ChiariⅠ型畸形连续病例为研究对象；其中 63 例接受脑扁桃体软膜切除术患者纳入 A 组，32 例接受硬膜扩大修补术患者纳入 B 组；比较 2 组手术资料及术后 6 个月时的临床症状、脑脊液动力学情况，并统计术后 12 个月内并发症发生率，采用芝加哥 Chiari 畸形预后量表（CCOS）评价其预后。结果 A 组手术时间显著长于 B 组（P<0.05），但 2 组术中失血量、引流量、引流管留置时长、术后住院时间、总住院时间差异无统计学意义（P>0.05）；术后 2 组 Klekamp 神经评分系统疼痛、感觉障碍、运动障碍、共济失调评分较术前均显著下降，但 2 组术后 Klekamp 神经评分系统疼痛、感觉障碍、运动障碍、共济失调评分及脊髓空洞闭合或消失比例差异无统计学意义（P>0.05）；治疗后 2 组每搏输出量（SV）、平均流量（MF）较术前显著上升，尾端最大峰值流速（peak velocity，Vmax）、头端 Vmax 较术前显著下降，但 2 组 SV、MF、尾端 Vmax、头端 Vmax 组间比较差异无统计学意义（P>0.05）；A 组头痛头晕发生率显著高于 B 组（P<0.05），但 2 组发热、皮下积液、伤口感染及并发症总发生率差异无统计学意义（P>0.05）；2 组 CCOS 评分等级差异无统计学意义（P>0.05）。结论 脑扁桃体软膜切除术与硬膜扩大修补术对ChiariⅠ型畸形患者术后临床症状、脑脊液动力学及预后的改善相当，但前者手术时间更长，术后头痛头晕发生率更高，值得临床重视。
【关键词】 小脑扁桃体下疝畸形；脑扁桃体软膜切除术；硬膜扩大修补术；临床症状；脑脊液；预后
【中图分类号】 R651.1+ 1 【文献标识码】 A 【文章编号】 1673-5110 （2022） 07-0839-07
DOI：10.12083/SYSJ220215
Clinical comparative analysis of cerebellar tonsillectomy and dural expansion repair
DONG Xiancheng，CHEN Zhong，ZOU Kunliang，DENG Gongjian，LANG Qing
Dazhou Central Hospital，Dazhou 635000，China
Corresponding author：CHEN Zhong
【Abstract】 Objective To analyze the influence of subpial cerebellar tonsillectomy and dural expansion repair on clinical symptoms，cerebrospinal fluid dynamics and prognosis of patients with cerebellar subtonsillar hernia（Chiari malformation）.Methods Totally 95 consecutive patients with Chiari Ⅰ malformation diagnosed by MRI were selected as the research subjects between January 2017 and January 2020.Among them，63 patients treated with subpial cerebellar tonsillectomy were included in group A，while 32 patients treated with dural expansion repair were included in group B. The surgical data，clinical symptoms and cerebrospinal fluid dynamics at 6 months after surgery were compared between the two groups. The incidence of complications within 12 months after surgery was calculated.The prognosis was evaluated with the Chicago Chiari Outcome Scale（CCOS）. Results The surgical time of group A was significantly longer than that of group B（P<0.05），but there were no statistically significant differences between th
e two groups in intraoperative blood loss，drainage volume，drainage tube indwelling time，postoperative hospital stay，and total length of hospital stay（P>0.05）. After surgery，the scores of pain，sensory disturbance，dyskinesia，and ataxia in the Klekamp neurologic score were significantly reduced in the two groups，but the above scores and the proportion of closure or disappearance of syringomyelia showed no statistically significant differences between the two groups（P>0.05）. After treatment，the stroke volume（SV）and mean flow（MF）were significantly increased，and the tail-end peak velocity（Vmax）and head-end Vmax were significantly reduced in the two groups，but there were no significant differences in these indicators between the two groups（P>0.05）. The incidence of headache and dizziness in group A was significantly higher than that in group B（P<0.05），but the total incidence of fever，subcutaneous effusion，wound infection and complications showed no statistically significant difference between the two groups（P>0.05）. There was no statistically significant difference in CCOS score between the two groups （P>0.05）. Conclusion Subpial cerebellar tonsillectomy and dural expansion repair can achieve equivalent effects in improving postoperative clinical symptoms，cerebrospinal fluid dynamics and prognosis of patients with Chiari I malformation.However，the duration of the former is longer and the incidence of postoperative headache and dizziness is higher，which is worthy of clinical attention.
【Key words】 Chiari malformation；Subpial cerebellar tonsillectomy；Dural expansion repair；Clinical symptom；Cerebrospinal fluid；Prognosis
