The effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt on the treatment effect, inflammatory factors and immune function in patients with hydrocephalus / 中国医师进修杂志

ABSTRACT

Objective:To investigate the therapeutic effect of ventriculoscopy combined with laparoscopy in ventriculoperironeal shunt (VPS) on the treatment effect, inflammatory factors and immune function in patients with hydrocephalus.Methods:A retrospective study was conducted on 76 patients with hydrocephalus in Traditional Chinese Medicine Hospital of Jining from March 2017 to September 2019, and they were divided into observation group (39 cases) and control group (37 cases) according to different treatment procedures. The control group performed traditional VPS, and the observation group performed ventricoscopy combined with laparoscopy in VPS. The incidence of postoperative complications and the treatment effect at 6 months after the operation, serum inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-10, IL-6, immune function indexes CD 3+, CD 4+, CD 4+/CD 8+before and 1 d and 3 d after the operation, Glasgow Outcome Scale (GOS) and Modified Rankin Scale (MRS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI) and Generic Quality of Life Inventory 74 (GQOL-74) before operation, 3 and 6 months after operation were compared between the two groups. Results:The total effective rate in the observation group at 6 months after operation was higher than that in the control group 94.9% (37/39) vs. 73.0% (27/37), and the difference was statistically significant ( χ2 = 0.848, P<0.05). The GOS scores in the observation group were higher than those in the control group at 3 months and 6 months after surgery (3.68 ± 0.49) scores vs. (3.02 ± 0.51) scores, (4.17 ± 0.24) scores vs. (3.59 ± 0.43) scores; and the MRS and NIHSS scores were lower than those in the control group (2.05 ± 0.15) scores vs. (2.84 ± 0.17) scores and (1.62 ± 0.11) scores vs. (2.17 ± 0.14) scores, (12.97 ± 3.82) scores vs. (16.05 ± 4.61) scores and (10.90 ± 2.75) scores vs. (13.84 ± 3.29) scores; and the differences were statistically significant ( P<0.05). The serum levels of TNF-α and IL-6 in the observation group were lower than those in the control group at 1 and 3 d after surgery, and IL-10 level was higher than that in the control group, and the differences were statistically significant ( P<0.05). The CD 3+, CD 4+, and CD 4+/CD 8+ levels in the observation group were higher than those in the control group at 1 and 3 d after operation, and the differences were statistically significant ( P<0.05). The postoperative complications in the observation group was lower than that in the control group 29.7% (11/37) vs. 10.3% (4/39), and the difference was statistically significant ( χ2 = 4.383, P<0.05). The BI and GQOL-74 scores in the observation group at 3 and 6 months after operation were higher than those in the control group ( P<0.05). Conclusions:The combination of ventricoscopy and laparoscopic in VPS can reduce the impact on immune function by reducing the inflammatory stress response, reduce the occurrence of postoperative complications, and further promote the improvement of prognosis.