儿童结核性脑膜炎脑积水Ommaya囊内注药外引流治疗的体会  

Role of Ommaya reservoir in pediatric tuberculous meningitis hydrocephalus

作　　者：林坚[1] 周辉[1] 许尚虞[1] 尹波[1] 盛汉松[1] 张弩[1] 

机构地区：[1]温州医学院附属第二医院(育英儿童医院)神经外科,325027

出　　处：《中华小儿外科杂志》2012年第8期597-599,共3页Chinese Journal of Pediatric Surgery

基　　金：浙江省科技厅公益技术研究社会发展项目（编号：2010C33090）

摘　　要：目的探讨Ommaya储液囊治疗儿童结核性脑膜炎脑积水的疗效。方法结核性脑膜炎伴脑积水患儿12例，男9例，女3例，体重6～38kg，年龄4个月至12岁。Ⅱ级6例，Ⅲ级4例，Ⅵ级2例。12例均采用储液囊植入，囊内穿刺引流、注药方法治疗。结果术前脑脊液白细胞数、蛋白含量分别是：（228±139）×10^6／L、（2．18±1．26）g／L；储液囊内给药2周后白细胞数（21±18）×10^6／L、蛋白含量（0．69±0．34）g／L。植入12个储液囊，最终取出储液囊8个，长期留置4个，4例再次行V-P分流术。结论Ommaya储液囊具有操作方便，可随时反复抽取脑脊液检查，避免腰穿；留置时间长，不易感染；经囊内给药起效快等优点。此方法可能更适用于轻中度脑积水且预计短期内脑积水可缓解的患儿。部分患儿可避免长期分流管的植入。Objective This study aims to discuss the use of subcutaneous reservoir drainage to treat tuberculous meningitis hydrocephalus in children. Methods Retrospective analysis of 12 cases of tuberculous meningitis hydrocephalus in children was carried out. Ommaya reservoir was used for intraventricular infusion of medication and aspiration of cerebrospinal fluid for the treatment of raised in- tracranial pressure. Results The numbers of white cells and protein from preoperative cerebrospinal fluid were 228 -＋ 139（lOC＇/L）and 2. 18 ＋ 1.26（g/L）. After treating for two weeks,the numbers of white cells and protein decreased to 21 ＋ 18（ 106/L） and 0. 69＋0. 34（g/L）. Twelve Ommaya reservoirs were implanted; eight reservoirs were removed and four were long-term indwelling. In four cases, V-P shunts had to be implemented. Conclusions Implantation of Ommaya reservoir for treatment of tuber- culous meningitis hydrocephalus is simple and effective. It produced less trauma and fewer complica- tions. This method may be more suitable for children with mild or moderate hydrocephalus, and who are expected to improve in the short term.

关 键 词：结核性脑膜炎 脑积水 

分 类 号：R726.5[医药卫生—儿科]