儿童颞部中型蛛网膜囊肿两种术式的疗效分析  

Therapeutic effects of two neurosurgical approaches on temporal medium-sized arachnoid cyst in pediatric patients

作　　者：叶玉勤[1] 李泽[1] 贾颜锋[1] 屈延[1] 李兵[1] 蒋晓帆[1] 刘卫平[1] 费舟[1] 贺晓生[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《中华神经医学杂志》2016年第3期274-278,共5页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金（81171155、81471264）

摘　　要：目的通过疗效分析探讨儿童蛛网膜囊肿的最佳手术治疗方式。方法回顾性分析第四军医大学西京医院神经外科自2012年6月至2014年6月手术治疗的78例颞部中型蛛网膜囊肿患儿的临床资料，其中囊肿-腹腔分流术治疗41例（分流组），开颅囊肿切除术治疗37例（开颅组）。术后3-24个月，对所有患儿的囊肿体积变化和临床症状改善情况进行随访。结果2种术式均能有效使减小囊肿体积，但时程特点不同：术后3个月时，开颅组囊肿的减小程度优于分流组，差异有统计学意义（P〈0.05）；术后6、12、18个月，2组囊肿进一步减小；但术后24个月时，分流组囊肿的减小程度明显优于开颅组，差异有统计学意义（P〈0.05）。2种术式均能明显改善临床症状，但2组患者术后症状综合自评结果，比较差异无统计学意义（P〉0.05）。结论对于儿童颞部中型蛛网膜囊肿，开颅囊肿切除术和囊肿-腹腔分流术均能有效减小囊肿体积和改善临床症状，但疗效各具特点：前者的早期疗效较为显著，后者的远期效果更为突出。Objective To explore therapeutic effects of two different neurosurgical approaches on pediatric patients with arachnoid cyst. Methods Seventy-eight hospitalized pediatric patients with temporal medium-sized arachnoid cyst, admitted to our hospital and accepted neurosurgical operations from June 2012 to June 2014, were included in the study. Cyst-operitoneal shunting was performed in 41 patients whereas craniotomy in 37 patients. Follow-up was obtained for all the patients in a period of 3-24 months. Results The arachnoid cyst volume decreased in various degrees following either cyst-operitoneal shunting or craniotomy. The arachnoid cyst volume in the craniotomy group reduced more obviously than that in the cyst-operitoneal shunting group 3 months after operation, with significant difference （P〈0.05）; the cyst continued to shrink at 6, 12, 18 months after operation. However, the cyst volume in the shunting group was much smaller than that in the craniotomy group 24 months after operation, with significant difference （P〈0.05）. The neurological symptoms caused by arachniod cyst improved due to surgical treatment, and self-evaluation revealed no significant difference between the two groups concerning symptomatic improvement rate （P〉0.05）. Furthermore, postoperative complications were seldom found among the patients, such as intracranial infection, lateral fissure vascular injury and excessive CSF shunting. Conclusions For temporal medium-sized arachnoid cyst, either craniotomy or shunting reduces arachnoid cyst volume in various degrees and improves the neurological symptoms in pediatric patients. However, the therapeutic effect shows difference in strength at various postoperative periods. Better effect is noted in earlier postoperative period for craniotomy, and in later postoperative period for cyst-operitoneal shunting.

关 键 词：蛛网膜囊肿 神经外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]