神经内镜下三脑室底造瘘术治疗儿童先天性梗阻性脑积水疗效分析  

An analysis of operative success rate and postoperative neurodevelopmental outcome of endoscopic third ventriculostomy at different age groups in pediatric patients with congenital obstructive hydrocephalus

作　　者：特吾尔巴提.苏尔旦尼亚 巴哈提.哈立亚[2] 阿合买提.沙买提 汪永新[1] 吉文玉[1] 更.党木仁加甫[1] 

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054 [2]新疆医科大学第一附属医院放射科,乌鲁木齐830054 [3]新疆医科大学第一附属医院中心手术室,乌鲁木齐830054

出　　处：《新疆医科大学学报》2015年第3期325-328,共4页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81160150)

摘　　要：目的探讨不同年龄段儿童先天性梗阻性脑积水行神经内镜下三脑室底造瘘术(ETV)治疗疗效及术后神经发育预后。方法选择33例经ETV治疗的先天性梗阻性脑积水患儿,根据手术年龄段分为ETV≤6个月组(n=17)与ETV>6个月组(n=16),术后随访6个月,并采用"Gesell儿童智力发育诊断量表"进行神经发育评测,包括大运动行为、精细运动行为、适应能力、语言功能及个人-社会行为。比较两组患儿手术成功率与术后神经发育状态。结果 ETV≤6个月组与ETV>6个月组术后神经发育预后具有统计学差异(P<0.05),ETV≤6个月组患儿在大运动行为、精细运动行为、适应能力、语言功能及个人-社会行为方面均不如ETV>6个月组患儿;ETV≤6个月组患儿中,重度神经发育障碍17例(100%)(DQ值<40),手术成功率为35.3%,而ETV>6个月组患儿中重度神经发育障碍1例(6.25%),手术成功率为62.5%。结论出生6个月以内儿童先天性梗阻性脑积水行神经内镜下三脑室底造瘘术(ETV)治疗手术成功率低,术后神经发育预后欠佳。Objective To discuss the effect of endoscopic third ventriculostomy （ETV） at different age groups on operative success rate and the postoperative neurodevelopmental outcome in pediatric patients with congenital obstructive hydrocephalus. Methods We evaluated the postoperative neurodevelopmental outcome in 33 children with congenital obstructive hydrocephalus who underwent endoscopic third ventric- ulostomy at different age groups from June 2011 to June 2014. According to their age at the time of surger- y, we categorized them into two groups： ETV≤6 months group （n = 17）and ETV〉6 months group （n = 16）. We assessed postoperative neurodevelopmental outcome by means of Gese11 developmental diagnosis schedule （including gross motor, fine motor, adaptive, linguistic and personal--social functions）, and studied the operative success rate. Results There was statistical significance between two groups on neu- rodevelopmental outcome （P 〈0.05）, ETV〉6 months group patients presented better outcome score in all assessed domains than ETV≤6 months group individuals. In ETV≤6 months group, 16 （100%） patient had severe neurodevelopmental disability compared with 1 （6.25 %） children in ETV）6 months group. Success rate of the former was 35.3o//oo, whereas the rate of the latter was 62.5%. Conclusion The operative success rate of endoscopic third ventriculostomy for children younger than 6 months with ob- structive hydrocephalus is low and the neurodevelopmental outcome is poor.

关 键 词：先天性梗阻性脑积水 三脑室底造瘘术 神经发育预后 

分 类 号：R651[医药卫生—外科学]