神经内镜治疗儿童鞍上池囊肿的术后并发症分析  

Postoperative complications of neuroendoscopic treatment of suprasellar cysts in children

作　　者：邹哲伟[1] 冀园琦[1] 

机构地区：[1]首都医科大学附属北京儿童医院神经外科,100045

出　　处：《中华小儿外科杂志》2016年第3期172-176,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨分析应用神经内镜脑室囊肿脑池造瘘术（VCC）治疗儿童鞍上池囊肿的术后并发症。方法回顾性分析2008年4月至2014年11月北京儿童医院神经外科收治的23例鞍上池囊肿患儿的临床资料。其中，男12例，女11例；年龄6个月～5岁，平均1．99岁。临床表现以颅内压增高为主，影像学检查证实鞍上池囊肿合并脑积水。全部病例应用神经内镜行脑室囊肿脑池造瘘术（VCC）治疗，术后随访3个月～5年。结果并发症包括抽搐8例，出现时间为术后1～19h，平均5h，经镇静治疗后抽搐消失，未遗留癫痫。发热23例，均为中一高度发热，持续2～7d，反复腰椎穿刺检查证实为非感染性一过性发热。低钠血症2例，经静脉补钠治疗缓解。硬膜下积液2例，均为婴儿期（〈1岁）患儿，随诊半年后积液消失。皮下积液并伤口感染1例，经脑室外引流伤口清创后痊愈。术后随访全部病例未见囊肿复发。结论神经内镜是治疗鞍上池囊肿的首选方法。抽搐和发热是术后常见并发症，尤其对于婴幼儿。抽搐与患儿年龄、术后颅内压急剧变化及发热有关。术中应注意冲洗液温度和流速控制，缩短操作时间，减少颅内压的骤然变化；术后注意降温、镇静治疗，长期预后良好。术后发热为非感染性一过性症状，术后对症治疗及反复腰椎穿刺引流脑脊液后可有效控制。术后低钠血症与过度烧灼和剪除囊肿壁有关，囊肿造瘘时应尽量选择无血管区并避免过度烧灼囊肿壁，减少术后电解质紊乱的发生。Objective To explore the postoperative complications of neuroendoscopic treatment of suprasellar cysts in children. Methods From April 2008 to November 2014,a total of 23 children of suprasellar cysts, including 12 males and 11 females with a mean age of 1.99 years, underwent neuroendoscopy. Intracranial hypertension and suprasella cysts with hydrocephalus were detected on preoperative magnetic resonance imaging （MRI）. Endoscopic ventriculocystocisternostomy was performed. Results During a follow-up period of 3 months to 5 years, there was no recurrence. Postoperative convulsion （n = 8） occurred at an average of 5 （1-19） h （average 5 h） and was cured with sedatives. And there was no epileptic sequelae. Moderate-to-high fever lasted for 2-7 days. Postoperative lumber puncture and cerebrospinal fluid examination showed no central nerve system infection. Two cases of hyponatremia were cured with an intravenous infusion of sodium. Subdural effusion disappeared after 6 months in 2 cases. And another case of subcutaneous infective hydrops was cured after external ventricular drainage and wound debridement. Conclusions Neuroendoseopic therapy is a first option for suprasellar cysts in children. Postoperative convulsion and fever are common complications, especially for infants. Correlated with patient age, abrupt changes of intracranial pressure and postoperative fever, convulsion may be reduced by controlling temperature and flow rate of ventricular irrigation during procedure and shortening operative duration for avoiding abrupt changes of intracranial pressure. Postoperative measures include sedation and symptomatic therapy. Fever is transient and non-infective. Hyponatremia is correlated with excessive destruction of cystic wall. It is necessary to minimize the destruction of cystic wall vasculature and avoid the sites of extensive vascular striae.

关 键 词：神经内窥镜 脑室造口术 囊肿 手术后并发症 

分 类 号：R726.5[医药卫生—儿科]