神经内镜下第三脑室底造瘘术治疗儿童脑积水的疗效评估  

Therapeutic effect of endoscopic third ventriculostomy for pediatric hydrocephalus

作　　者：关峰[1] 胡志强[1] 黄辉[1] 朱广通[1] 毛贝贝[1] 康庄[1] 王元景[1] 侯宇希[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院神经外科, 100038

出　　处：《中华医学杂志》2014年第17期1334-1337,共4页National Medical Journal of China

基　　金：首都卫生发展科研专项项目（2011-2008-06）;首都临床特色应用研究（Z131107002213044）

摘　　要：目的 评估依据儿童特点建立的评分量表（ETVSS）预测神经内镜下第三脑室底造瘘术（ETV）疗效的准确性.方法 依据ETVSS量表的评分,将北京世纪坛医院神经外科2007年6月至2010年6月期间收治的121例脑积水患者分为高、中、低分值组.采用x2检验以及95％可信区间将ETV术后6个月以及24个月的实际成功率与预测平均成功率相比较.远期成功率采用Kaplan-Meier生存分析计算.结果 ETV术后6个月高分值组的实际成功率略低于预测的平均成功率,而中、低分值组的实际成功率均略高于预测的平均成功率.ETVSS量表准确地预测了ETV术后24个月的结果：低、中、高分值组的实际成功率分别为74％ （37/50）、62％ （28/45）和42％ （11/26）,预测平均成功率为81.3％,61.4％和34.4％.结论 ETVSS量表能够准确预测低、中、高分值组的远期成功率,为外科医生在术前准确预测儿童脑积水ETV的疗效提供帮助.Objective To validate the proposed endoscopic third ventriculostomy success score （ETVSS） for predicting successful ETV outcomes for pediatric hydrocephalus on the basis of individual characteristics.Methods For 121 cases at our department from June 2007 to June 2010 at both 6 and 24 months,Actual successful rates were compared with Chi-square test and 95% confidence interval for low,moderate and high chance of success strata based on the ETVSS.Long-term successful probability was calculated with Kaplan-Meier methods.Results The 6-month ETV successful rate was higher than the mean predicted probabilities of success for both moderate and low success strata,but slightly lower for the high chance of success strata.The ETVSS accurately predicted the outcomes at 24 months ; the low,medium and high chance of success strata had actual success rates of 74% （37/50）,62% （28/45） and 41% （11/26） and mean predicted successful probabilities of 81.3%,61.4% and 34.4% respectively.Conclusion ETVSS may accurately predict the overall long-term successful rates in high,moderate and low-risk groups.Thus it will aid clinical decision-making through predicting the therapeutic effect of ETV.

关 键 词：脑积水 神经内镜 第三脑室底造瘘术 疗效 

分 类 号：R726.5[医药卫生—儿科]