新生儿期神经管闭合不全手术治疗和疗效分析  

Effectiveness of surgery on neonatal neural tube dysraphism

作　　者：孙莲萍[1] 金惠明[1] 马杰[1] 龚一鸣[1] 赵阳[1] 江峰[1] 

机构地区：[1]上海交通大学医学院附属新华医院小儿神经外科,200092

出　　处：《临床外科杂志》2012年第8期540-542,共3页Journal of Clinical Surgery

摘　　要：目的分析新生儿期神经管闭合不全术后远期效果及其治疗意义。方法所有新生儿期人院患儿经头颅或脊髓MRI检查明确诊断，76例患儿中11例未治疗，24例急诊手术，41例限期手术，术前、术后对大小便和下肢运动功能评价。结果11例未手术患儿中5例无手术指征，6例家长放弃，术后半年以上得到远期随访病例50例，占治疗者76．9％，平均随访时间（43．06±28．36）个月，原有症状均有改善，46．1％存在大小便障碍，33．3％留有运动功能障碍，22％智力落后。结论新生儿期就诊的神经管闭合不全患儿应在评估生存质量基础上取舍手术，有手术指征者应及时治疗，对防止神经功能继发性损害具有积极意义。Objective To analyze the patients who developed neural tube dysraphism in the neo- natal period. The therapeutic significance was studied by investigating the surgical indication, methods and long-term result according to pathologic types. Methods Among all the patients who had been diagnosed by the brain and spinal MRI scan, 11 cases were untreated ,24 cases accepted emergency operation and 41 of them had limited operation. Pre-and post-operative functions of bladder, anal sphincter, and motor function were evaluated. Results Eleven patients did not receive surgery because of the absence of surgical indication（ n = 5 ）or being given up by parents （n = 6 ）. Fifty patients （76.9%）were followed-up for over half a year whose mean follow-up time was 43.06 ± 28.36 month,and had improved symptoms. 46.1% of patients had disturbance of bladder and anal functions. 33.3% of patients suffered reduced motor func- tions. In addition, 22% of patients had mental retardation. Conclusion In the newborn with dysraphic malformation, the surgery must be taken or given up according to the assessment of their life quality. The timely operation would be significantly helpful to their late functional improvement.

关 键 词：新生儿 脑膜脑膨出 (脂肪)脊髓脊膜膨出 隐 性神经管闭合不全 

分 类 号：R651.1[医药卫生—外科学]