脑室镜下手术治疗早产儿重度梗阻性脑积水  

Effect of endoscopic third ventriculostomy in treating severe obstructive hydrocephalus in premature infant

作　　者：陈红武[1] 薛乔[1] 彭玉平[2] 

机构地区：[1]南方医科大学附属南方医院新生儿科,广州510515 [2]南方医科大学附属南方医院神经外科,广州510515

出　　处：《中华实用儿科临床杂志》2013年第8期635-637,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨脑室镜下三脑室造瘘术治疗早产儿重度梗阻性脑积水的疗效和安全性。方法对CT、MR[或颅脑B超证实为重度梗阻性脑积水的11例早产儿，采用经侧脑室、室问孔、三脑室置入神经内镜，于三脑室底与脚间池造一瘘孔。比较手术前后脑室系统B超测量左右侧脑室的改变以及MRI和CT的影像学改变；追踪观察手术并发症、手术效果和安全性，采用贝利婴幼儿量表和Peabody运动功能量表评估患儿神经系统状况。结果术后随访0．5～6．0年，11例中9例远期效果良好，1例脑室仍轻度增大但维持稳定，1例无变化，1例脑室进行性增大改行脑室腹腔分流术。头颅B超测量左右侧脑室宽度术前为（9．60±3．52）mm和（8．63±3．10）mm，术后下降为（5．50±2．20）mm和（4．90±2．70）mm。本组11例患儿侧脑室旁水肿均消失，其中随访时间〉12个月9例，梗阻性脑积水临床症状均缓解。结论脑室镜下手术可显著改善重度梗阻性脑积水的近远期不良预后，是一种安全、有效、并发症少的微创手术。Objective To discuss the treatment and the clinical effect of endoscopic third ventriculostomy on severe obstructive hydrocephalus in premature infant. Methods Eleven patients were operated, ultrasound, CT and MRI showed severe obstructive hydrocephalus and cerebral spinal fluid absorption was normal. The technique was that endoscope was inserted through the foramen of Monro into the third ventricle, then perforating the floor of the third ven- triculostomy. Comparison before and after surgery of ventricular system ultrasonic measurement about the change of lateral ventricle and the MRI and CT imaging changes were performed. The complications, operation effect and security were observed. The bailey baby scale and Peabody movement function scale was used to assess the patient＇s neurologie system status. Results The follow-up time was 6 months and 6 years after operation, an excellent operative result was got in 9 cases. The ventricular width of 1 patient was mild ventriculomegaly, but stayed stabilily. No change of ventricu- lar width was found in 1 case. Additional shunt were needed in 1 Case. No severe complications were found. The left and fight lateral ventricle measured by ultrasonic before operation were （9.60 ±3.52 ） mm and （ 8.63 ± 3.10） mm before operation, and （ 5.50±2.20 ） mm and （4. 90 ± 2.70） mm after operation. The 11 cases of lateral ventricle side edema were disappeared, the follow-up time in 9 cases were more than 12 months, obstructive hydrocephalus clinical symptoms were relieved. Conclusions Ventricular mirror operation significantly improve severe hydrocephalic short and long- term poor prognosis,it is a safe, effective and less complications of minimally invasive surgery.

关 键 词：梗阻性脑积水 神经内镜 三脑室造瘘术 婴儿 早产 

分 类 号：R651.1[医药卫生—外科学]