儿童先天性脑积水的诊治探讨  

Diagnosis and treatment of congenital hydrocephalus in children

作　　者：刘智强[1] 刘水源[1] 林志雄[1] 梅文忠[1] 龚清永[1] 何理盛[1] 康德智[1] 吴喜跃[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005

出　　处：《中华神经医学杂志》2013年第8期846-848,共3页Chinese Journal of Neuromedicine

摘　　要：目的 探讨并总结儿童先天性脑积水的诊治经验. 方法 回顾性分析福建医科大学附属第一医院神经外科自2007年6月至2011年6月收治的29例儿童先天性脑积水患者的临床资料,其中合并神经系统畸形27例,包括胼胝体缺如或发育不全6例、导水管狭窄5例、脑膜膨出3例、脊膜膨出3例、Dandy-Walker畸形2例、Chiari 1型畸形1例、脑灰质异位并脑裂畸形1例、脑发育不全1例、脑裂畸形1例、神经纤维瘤病1型1例、第四脑室囊肿1例、枕大池囊肿1例、透明隔囊肿1例；伴其他脏器畸形4例,包括胸7半椎体脊柱侧弯并右足马蹄内翻足1例、乳糜漏1例、腹股沟斜疝1例、脐疝1例.26例患者行脑室腹腔分流术,3例行囊肿腹腔分流术,均应用可调压分流管. 结果 29例患者中有效26例,疗效不佳3例.术后出现并发症13例,其中分流管感染3例,分流管近端堵塞或引流不畅3例,分流管腹腔端堵塞或引流不畅3例,硬膜下积液1例,硬膜下积液并硬膜下血肿1例,腹腔囊肿1例,分流管人右侧阴囊并阴囊肿胀1例. 结论 儿童先天性脑积水常合并脏器发育畸形,应注意相关检查以明确,并针对性治疗,以改善预后.Objective To summarize the diagnosis and treatment experience of congenital hydrocephalus in children.Methods The clinical data of 29 children with congenital hydrocephalus,admitted to our hospital from June 2007 to June 2011,were analyzed retrospectively; in these patients,27 had combined nervous system malformations,including corpus callosum agenesis or hypoplasia in 6,aqueduct stenosis in 5,meningocele in 3,spinal meningocele in 3,Dandy-Walker malformation in 2,Chiaril malformation in 1,Heterotopic gray matter combined with schizencephaly in 1,atelencephalia in 1,schizencephaly in 1,neurofibromatosis type 1 in 1,fourth ventricle cysts in 1,arachnoid cyst in cerebello-medullary cistern in 1 and septum pellucidum cysts in 1; 4 was associated with other organs malformations,including 1 case of hemivertebral deformity at T7 and right talipes equinovarns,1 case of chyle leakage,1 case of indirect inguinal hernia and 1 case of umbilical hernia.Ventriculoperitioneal shunt was performed in 26 cases,and 3 underwent cyst-peritoneal shunt surgery.Results Among the patients,26 cases had good prognosis after surgery,and the other 3 cases had poor outcome.13 appeared postoperative complications,including Shunt infection in 3,proximal shunt blockage or poor drainage in 3,peritoneal shunt blockage or poor drainage in 3,subdural effusion in 1,subdural effusion and subdural hematoma in 1,abdominal cyst in 1 and shunt tube into the right side of the scrotum and scrotal swelling in 1.Conclusion Congenital hydrocephalus in children often merges with other organs malformations;it＇s important to pay attention to the relevant examination and make clear diagnosis to improve the prognosis.

关 键 词：先天性脑积水 儿童 脏器发育畸形 

分 类 号：R742.7[医药卫生—神经病学与精神病学]