婴儿脉络丛乳头状瘤术前脑积水程度与预后的关系  

Severity of preoperative hydrocephalus is an important prognostic factor of choroid plexus papilloma in children

作　　者：孙骇浪[1] 赵凤毛[1] 冀园琦[1] 

机构地区：[1]北京儿童医院神经外科,北京100045

出　　处：《中华小儿外科杂志》2013年第3期165-168,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探究婴儿脉络丛乳头状瘤（CPP）术前脑积水程度的判定与预后之间的关系，讨论各种因素对于患儿预后的影响。方法回顾性分析2006年9月至2011年12月间收治的手术切除并经病理检查证实的11例1岁以内婴儿幕上CPP的临床资料，并在随后4个月～6年内进行随访（其中1例失访），对患儿预后情况进行全面评估。依据Vassilouthis法在CT及MRI片上进行脑室-颅比率测定，判定患儿术前脑积水程度。同时测量脑室额角宽度和侧脑室颞角扩大长度加以确认。采用统计学Fisher精确概率法分析患儿术前脑积水程度不同与其预后之间的关系。结果随访到10例幕上CPP患儿平均年龄为7．4个月，男女之比为3：7。其中，6例术前脑积水程度判定为轻度，4例则为重度。根据随访结果，进行全面评估，6例术前轻度脑积水患儿预后明显改善；但4例术前重度脑积水患儿中，3例预后不佳，未见明显改善。经Fisher精确概率法，两组间差异有统计学意义（P=0．033）。结论婴儿CPP术前脑积水严重程度是预后的决定性因素。瘤体大小、位置、手术切除、脑室一腹腔分流术等因素对患儿整体预后的影响尚需讨论，制定个体化治疗方案。婴儿CPP术后并发硬膜下积液较多，其发生机制，应对措施及远期预后值得探究。Objective To explore the correlation between severity of preoperative hydrocephalus and the prognosis of choroid plexus papilloma （CPP＇） in children. Methods Between Sep 2006 and Dec 2011, 11 patients with CP-P underwent surgery at this center. The diagnosis of CPP was confirmed by pathological examination. After surgery, 10 cases were followed up for 4 months to 6 years.The severity of hydrocephalus was determined on CT and MRI by calculating the ventricle to cranial ratio according to the Vassilouthis method. Meanwhile, width of ventricle forehead and length of lateral ventricles temporal angle were also calculated. Fisher exact test was performed to explore the correlation between preoperative hydrocephalus and the surgery outcome. Results The patients included 3 males and 7 females, with an average age of 7. 4 months. Six patients had mild preoperative hydrocephalus, and the other 4 had severe preoperative hydrocephalus. The symptoms of the 6 patients with mild preoperative hydrocephalus were significantly improved without severe complications after surgery. However, 3 of the 4 cases with severe preoperative hydrocephalus didn＇t get any significant improvement after surgery. Fisher analysis suggested that the clinical outcome of the 2 groups was significantly different （P = 0. 033）. Conclusions Severity of preoperative hydrocephalus is an important prognostic factor of choroid plexus papilloma in children.

关 键 词：乳头状瘤 脉络膜丛 脑积水 婴儿 

分 类 号：R726.5[医药卫生—儿科]