儿童先天性脑积水手术前后认知功能障碍的临床研究  

Clinical study of peoperative and postoperative cognitive dysfunction of children’s congenital hydrocephalus

作　　者：董留建 冯书彬 冯强 吕强 李涛 裴航 齐林 DONG Liujian;FENG Shubin;FENG Qiang;LYU Qiang;LI Tao;PEI Hang;QI Lin(Henan Children’s Hospital/Zhengzhou Children’s Hospital,Zhengzhou 450018,China)

机构地区：[1]河南省儿童医院郑州儿童医院,河南郑州450018

出　　处：《中国实用神经疾病杂志》2021年第10期899-904,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20190942)。

摘　　要：目的分析儿童先天性脑积水手术前后认知功能变化。方法回顾性分析2017-01—2020-01河南省儿童医院收治的120例先天性脑积水患儿的临床资料,其中ETV组65例,VPS组55例,ETV组进行第三脑室底造瘘术(ETV),VPS组采用脑室-腹腔分流术(VPS)。术后随访6个月,观察2组患者手术情况及术后随访情况,分析手术前后患儿认知功能改善情况。结果ETV组手术时间、术后排气时间均明显低于VPS组(P<0.05)。手术前后2组双侧脑室额角差值均较小(P>0.05)。术后随访6个月2组总有效率比较差异无统计学意义(P>0.05)。2组Kamofsky评分同期比较差异无统计学意义(P>0.05),2组术后Kamofsky评分均较术前显著升高(P<0.05)。术后VPS组分流管梗阻和腹腔感染发生率均显著高于ETV组(P<0.05),ETV组和VPS组患儿术后6个月发育商(DQ)高于术前且ETV组高于VPS组(P<0.05)。结论先天性脑积水患儿在进行ETV和VPS手术后病情和认知功能均能够得到有效改善,ETV术后并发症概率高于VPS组且认知功能障碍改善情况优于VPS组。Objective To analyze the changes of cognitive function and clinical effect of children with congenital hydrocepha⁃lus in Henan province before and after operation.Methods The clinical data of 120 children with congenital hydrocephalus treated in Henan Children's Hospital from January 2017 to January 2020 were analyzed retrospectively.The patients were divided into ETV group(n=65)and VPS group(n=55).ETV group underwent endoscopic third ventriculostomy(ETV),VPS group underwent ventricu⁃lar-peritoneal shunt(VPS).The patients in the two groups were followed up for 6 months.The operation and postoperative follow-up of the two groups were observed,and the improvement of cognitive function before and after operation was analyzed.Results The operation time and postoperative exhaust time in the ETV group were significantly lower than those in the VPS group,there was no sig⁃nificant difference in the difference of bilateral ventricular frontal angle between the two groups before and after operation,there was no significant difference in the total effective rate between the two groups after 6 months follow-up.There was no significant difference in the Kamofsky score between the two groups in the same period.The postoperative Kamofsky score in the two groups was sig⁃nificantly higher than that before operation.The incidences of shunt obstruction and abdominal infection in VPS group were signifi⁃cantly higher than those in ETV group(P<0.05).Six months after operation,the DQ in ETV group and VPS group was higher than be⁃fore operation,and that in ETV group was higher than VPS group(P<0.05).Conclusion The condition and cognitive function of chil⁃dren with congenital hydrocephalus can be effectively improved after ETV and VPS.The probability of postoperative complications in ETV group is higher than that in VPS group,and the improvement of cognitive impairment in postoperative follow-up is better than that in VPS group.

关 键 词：先天性脑积水 第三脑室底造瘘术 脑室-腹腔分流术 认知功能障碍 

分 类 号：R742.7[医药卫生—神经病学与精神病学]