儿童先天性脑积水的手术治疗效果分析  

Surgical Outcome of Congenital Hydrocephalus in Children

作　　者：吉文玉[1] 汪永新[1] 图柯拜 蔡宁 范雁东[1] 刘亮[2] 更.党木仁加甫[1] JI Wen-yu;WANG Yong-xin;TU Ke-bai;CAI Ning;FAN Yan-dong;LIU Liang;GENG · Dangmurenjiafu(Department ofNeurosurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Neurosurgery,Cancer Hospital Affiliated to Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,新疆乌鲁木齐市830054 [2]新疆医科大学附属肿瘤医院神经外科,新疆乌鲁木齐市830011

出　　处：《实用心脑肺血管病杂志》2018年第5期81-84,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C270)

摘　　要：目的分析儿童先天性脑积水的手术治疗效果。方法选取2015年1月—2017年3月新疆医科大学第一附属医院收治的先天性脑积水患儿70例,其中20例行内镜下第三脑室底造瘘术(ETV)者作为ETV组,27例行脑室-腹腔分流术(VPS)者作为VPS组,23例未接受手术治疗者作为对照组。分析3组患儿术后6个月病情改善情况,测定ETV组、VPS组患儿术前及术后2周、2个月、6个月脑室额角宽度、第三脑室宽度,采用Gesell发育诊断量表测定ETV组、VPS组患儿术前及术后2周、2个月、6个月发育商(DQ)。结果术后6个月ETV组患儿中病情改善者18例(占90%),病情无改善且脑室仍继续增大者2例(占10%);VPS组患儿中病情改善者27例(占100%);对照组患儿病情均无改善。ETV组患儿术后6个月脑室额角宽度、第三脑室宽度小于术前,DQ高于术前、术后2周(P<0.05);VPS组患儿术前及术后2周、2个月、6个月脑室额角宽度比较,差异无统计学意义(P>0.05),而术后6个月第三脑室宽度小于术前,术后2个月、6个月DQ高于术前、术后2周(P<0.05)。亚组分析结果显示,ETV组中>1岁与≤1岁患儿术后2周、2个月DQ比较,差异无统计学意义(P>0.05),而术后6个月≤1岁患儿DQ高于>1岁患儿(P<0.05);VPS组中>1岁与≤1岁患儿术后2周、6个月DQ比较,差异无统计学意义(P>0.05),而术后2个月≤1岁患儿DQ高于>1岁患儿(P<0.05)。结论 ETV和VPS均可有效改善先天性脑积水患儿病情及认知功能,但二者对患儿认知功能的改善效果一定程度上受到年龄影响,临床应合理选择手术方式。Objective To analyze the surgical outcome of congenital hydrocephalus in children. Methods A total of 70 children with congenital hydrocephalus were selected in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to March 2017,thereinto 20 cases received endoscopic third ventriculostomy were served as ETV group,27 cases received ventriculoperitoneal shunt were served as VPS group,the other 23 cases did not received surgical treatment were served as control group. Illness improvement effect in the three groups was analyzed respectively,width of ventricular frontal angle and third ventricle in ETV group and VPS group was respectively measured before surgery,2 weeks,2 months and 6 months after surgery,and Gesell Development Diagnosis Scale was used to evaluate the development quotient（DQ）in ETV group and VPS group before surgery,2 weeks,2 months and 6 months after surgery,respectively. Results After 6 months of surgery,the improvement effect of 18 cases（accounting for 90%）was significant in ETV group,but the improvement effect of the other 2 case（saccounting for 10%）was not significant,with further increasing of ventricle;the improvement effect of 27 case（saccounting for 100%）was significant in VPS group;no one got significant improvement effect in control group. Width of ventricular frontal angle and third ventricle 6 months after surgery was statistically significantly lesser than that before surgery,DQ 6 months after surgery was statistically significantly higher than that before surgery and 2 weeks after surgery in ETV group,respectively（P〈0.05）. No statistically significant differences of width of ventricular frontal angle was found in VPS group,before surgery,2 weeks,2 months and 6 months after surgery（P〈0.05）,while third ventricle 6 months after surgery was statistically significantly lesser than that before surgery,DQ 2 and 6 months after surgery was statistically significantly higher than that before surgery and 2 weeks after surgery in VPS group,respec

关 键 词：先天性脑积水 第三脑室底造瘘术 脑室-腹腔分流术 认知 治疗结果 

分 类 号：R742.7[医药卫生—神经病学与精神病学]