婴幼儿MMC合并Chiari畸形和脑积水临床研究  

A prospective study of hindbrain decompression + Torkldsen CSF diversion treating Chiari malformation and hydrocephalus in infants with myelomeningocele

作　　者：李太平[1] 

机构地区：[1]河南省人民医院神经外科,郑州450003

出　　处：《医药论坛杂志》2015年第11期14-16,19,共4页Journal of Medical Forum

摘　　要：目的探讨行限制性后颅窝、上颈髓减压联合Torkldsen分流术,治疗脊髓脊膜膨出(Myelomingocele MMC)婴幼儿合并脑积水和Chiari畸形的治疗效果,分析其并发症。方法本组34例患儿,均接受一期限制性后颅窝、上颈髓减压加Torkldsen分流加膨出囊修补术。存活病例获得随访。将术前、术后早期(2周内),术后6周和18周的并发症、脑干功能状态、Evans指数变化、颅内压变化、影像学变化作为本组的分析资料。结果本组34例中,28例(82.3%)最终获得满意或相对满意疗效,死亡4例(11.7%),3例死于颅内感染,1例出院后死于误吸。2例(5.9%)残留轻度后遗症。术后早期并发症主要有切口和颅内感染7例(20.5%),切口裂开4例(11.7%),脑脊液漏3例(8.8%),并可出现短时期脑干功能异常包括吞咽困难、喘鸣或/和呼吸暂停、声带麻痹。术后18周随访结果显示30例中24例(70.5%)颅内压恢复正常。16例(47.0%)Evans指数小于0.33。结论对于同时合并脑积水和Chiari畸形的MMC婴幼儿,一期行限制性后颅窝、上颈髓减压+Torkldsen分流加膨出囊修补术可以获得相对良好的效果。Objective To investigate the outcome and complications of hindbrain decompression ＋ Torkldsen CSF diver- sion ＋ MMC closure treating Chiari malformation （CM） and hydrocephalus in infants with myelomeningocele. Methods All 34 cases underwent one - stage surgical treatment including hindbrain decompression ＋ Torkldsen CSF diversion ＋ MMC closure. Follow - up was done for all survival cases. Data of preoperation, immediate postoperation （within 2 weeks） ,6 weeks after operation, 18 weeks after operation including complications, brain stem function, change of Evans index, IP and radiography was the focus of our analysis. Results 28cases （82. 3 % ） out of total 34 got complete or near- ly complete recovery with 4 cases （ 11.7% ） mortality of which majority were attributed to intracranial infection, and 2 cases （5.9%） had mild residual neurological deficits. Wound and intracranial infection, Wound dehiscence CSF leak- age comprise of immediate postoperation complications. Temporary neurogenic dysphagia, stridor or apnea, mild vocal cord paralysis were also seen at this time. IP got back to normal in 24cases （70. 5% ） while Evans index did in 16 eases （47. 0% ） 18 weeks after operation. Conclusion One - stage hindbrain decompression ＋ Torkldsen CSF diversion ＋ MMC closure could be successful in majority of MMC infants with Chiari malformation and hydrocephalus.

关 键 词：限制性后颅窝上颈髓减压术 Torkldsen分流术 脑积水 CHIARI畸形 脊髓脊膜膨出 婴幼儿 

分 类 号：R742.7[医药卫生—神经病学与精神病学]