婴幼儿脊髓脊膜膨出术后并发脑积水的影响因素及治疗方法分析  

Analysis of the influential factors and therapeutic methods for hydrocephalus after surgery for myelomeningocele in infants

作　　者：萧凯[1] 孙振兴[1] 修波[1] 崔志强[1] 段宏宇[1] 周荣凇[1] 

机构地区：[1]清华大学玉泉医院脊髓脊柱神经外科,北京100049

出　　处：《中国微侵袭神经外科杂志》2012年第9期400-402,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨婴幼儿脊髓脊膜膨出修补术后合并脑积水的影响因素及治疗方法。方法回顾性分析182例显微外科手术治疗脊髓脊膜膨出病儿的临床资料。根据术后是否并发脑积水分为脑积水组和对照组,多变量Logistic回归分析术后并发脑积水的影响因素;对脑积水组均先采取内科脱水治疗,再根据病情选择脑室外引流术(引流术)、第三脑室底造瘘术(造瘘术)和脑室-腹腔分流术(分流术)治疗。结果本组病儿术后发生脑积水26例,多变量Logistic回归分析:膨出部位在颈胸段、术后并发感染或脑脊液漏、脊膜膨出平均周径大、术前颅高压均为术后并发脑积水的影响因素。脑积水组采用单纯脱水治疗2例,脱水+引流术3例,脱水+引流术+造瘘术3例,脱水+引流术+分流术16例,脱水+引流术+造瘘术+分流术2例;经治疗治愈23例,死亡3例。结论针对脊髓脊膜膨出修补术后产生脑积水的不同病因,综合采用不同的治疗方式,可取得较好疗效。Objective To investigate the influential factors and therapeutic methods for hydrocephalus after surgery for myelomeningocele in infants. Methods Clinical data of 182 infants who received microsurgery for myelomeningocele were analyzed retrospectively. The patients were divided into control group and hydrocephalus group according to whether the patients developed postoperative hydrocephalus, and the influential factors for complicated hydrocephalus were analyzed by multivariate logistic regression. Firstly, dehydration was performed in patients in hydrocephalus group. Then, the procedures such as external ventricular drainage （EVD）, endoscopic third ventriculostomy （ETV） and ventriculoperitoneal （V-P） shunt were choose based on the patient＇s condition. Resdts The postoperative hydrocephalus occurred in 26 patients. Multivariable logistic regression analysis showed that the factors resulting in postoperative hydrocephalus included myelomeningocele in the cervicothoracic segment, postoperative infection or cerebrospinal fluid leakage, larger circumference and higher intracranial pressure at preoperation. The treatment in hydrocephalus group included single dehydration in 2 cases, dehydration plus EVD in 3, dehydration ＋ EVD ＋ ETV in 3, dehydration ＋ EVD ＋ V-P shunt in 16, dehydration ＋ EVD ＋ ETV ＋ V-P shunt in 2. Twenty-three patients were cured and 3 died. Condusions Hydrocephalus after surgery for myelomeningocele should be treated by comprehensive treatment according to etiology, which can get good effects.

关 键 词：脊髓脊膜膨出 脑积水 婴幼儿 影响因素 

分 类 号：R726.5[医药卫生—儿科]