Comparison Of Clinical Efficacy Of Endoscopic Third Ventriculostomy And Ventriculoperitoneal Shunt Surgery For Obstructive Hydrocephalus

Background:Hydrocephalus is a common neurosurgical disease,obstructive hydrocephalus,also known as non-communicating hydrocephalus,is caused by stenosis and obstruction in one channel of the ventricles.There are many ways to treat obstructive hydrocephalus caused by aqueduct stenosis,at present,commonly used methods are ventriculoperitoneal shunt(VPS)and endoscopic third ventriculostomy(ETV).The VPS is a traditional method of treatment,it has a wide range of adaptation,but it has many postoperative complications.In recent years,the development of endoscopic techniques has made ETV more and more widely used in the treatment of obstructive hydrocephalus and ETV has become an important clinical treatment.At present,a large number of studies have been conducted clinically on the efficacy of VPS and ETV for the treatment of obstructive hydrocephalus caused by aqueduct stenosis.Each treatment has its advantages and disadvantages.So far,there is still no "gold standard" for clinical choice of surgical methods.This article aims to provide a comprehensive evaluation of the clinical efficacy of ETV and VPS in the treatment of obstructive hydrocephalus caused by aqueduct stenosis and to explore the value of endoscopic treatment for hydrocephalus,which provides relevant basis for clinical work.Methods:A retrospective analysis method was used to count 93 cases of obstructive hydrocephalus patients which admitted to the Department of Neurosurgery,Qilu Hospital of Shandong University from January 1,2012 to July 1,2017.Among them,59 cases underwent ETV and 34 cases underwent VPS.Statistics of patients clinical data were collected and analyzed.The preoperative basic conditions,hospital stays,operation time,hospitalization costs,operative results,complications and other indicators were compared between the two groups,and the statistical analysis were performed by analysis of variance and Fisher's exact test.Results:There are differences in hospital stay,hospitalization costs,and operative time between ETV and VPS.Operative time:ETV(70.25±26.25)(minutes)vs VPS(97.35±40.55)(minutes).The operation time of ETV group was significantly less than that of VPS group(P<0.001);Hospitalization time:ETV(15.19)±4.13)(days)vs VPS(18.18±7.20)(days),hospitalization time in the ETV group was significantly lower than that in the VPS group(P<0.05);hospitalization costs:ETV(34354.25±11094.23)(yuan)vs VPS(48944.47±)14619.37)(yuan),the average hospitalization cost of ETV group was significantly less than that of VPS group,and the difference was statistically significant(P<0.001).Two groups of postoperative effective rates:recent:ETV(94.9%)vs VPS(91.2%),P=0.665>0.05;long-term:ETV(91.5%)vs VPS(82.3%),P = 0.187>0.05.There was no significant difference between the two groups in the near-term and long-term efficacy of surgical methods.Postoperative complications of the two groups:8 cases(13.6%)of overall complications in ETV group,11 cases(32.4%)of VPS group overall complications,the difference was statistically significant(?2=4.687,P=0.030<0.05).There was no statistical difference between the other complications(P>0.05).Conclusions:There is no significant difference in the effective rate of ETV and VPS in the treatment of obstructive hydrocephalus.However,compared with VPS,ETV has obvious advantages in reducing postoperative complications,and it can shorten the operation time and hospitalization time,reduce hospitalization costs.