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目的研究脑积水第三脑室底部的形态特征,并评估其对内镜下第三脑室底造瘘术(ETV)的影响。方法回顾性分析178例脑积水病人第三脑室底的形态特征,并探讨其对造瘘过程的影响及相关手术技巧。结果第三脑室底形态改变如下:宽度扩张167例,狭窄2例,正常9例;厚度变薄38例,增厚20例,正常120例;角度水平172例,倾斜6例;位置上凸12例,下陷31例,正常135例;解剖标志清晰169例,仅能分辨半透明膜及鞍背,漏斗和乳头体等结构模糊8例,完全无法分辨上述结构1例。ETV过程顺利143例,困难33例,无法完成2例。结论脑积水时第三脑室底解剖形态变异较大,第三脑室底增厚、下陷、倾斜等会增加ETV的操作难度。内镜下完全无法分辨半透明膜、漏斗及乳头体是ETV禁忌证。
Objective To investigate the morphological characteristics of the third ventricle at the bottom of the hydrocephalus and to evaluate its effect on endoscopic third ventriculostomy (ETV). Methods A retrospective analysis of 178 patients with hydrocephalus third ventricle at the bottom of the morphological characteristics and explore its impact on the fistula process and related surgical skills. Results The changes of the shape of the third ventricle were as follows: width expansion in 167 cases, stenosis in 2 cases and normal in 9 cases; thickness thinning in 38 cases, thickening in 20 cases and normal in 120 cases; angle in 172 cases and tilt in 6 cases; Cases, sag in 31 cases, normal 135 cases; 169 anatomical clear signs, can only distinguish the semitransparent membrane and saddle back, funnel and nipple and other structural fuzzy 8 cases, completely unable to distinguish the above structure in 1 case. 143 cases of ETV smoothly, 33 cases of difficulty, unable to complete 2 cases. Conclusions The third ventricle at the bottom of the hydrocephalus has a large variation in anatomical shape. The thickening, sag and tilt of the third ventricle increase the operational difficulty of ETV. Endoscopic completely unable to distinguish translucent membrane, funnel and nipple body is ETV contraindication.