后颅窝肿瘤合并脑积水患者围手术期脑积水的处理  

Experience in management of perioperative hydrocephalus in posterior fossa tumor patients

作　　者：董康 钟东[1] 杨佳[1] 武有涛 蒋宏 杨瑞 吴越[1] 黄志坚[1] 程崇杰[1] 夏海坚[1] 孙晓川[1] DONG Kang;ZHONG Dong;YANG Jia(Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《临床神经外科杂志》2021年第5期552-556,561,共6页Journal of Clinical Neurosurgery

基　　金：重庆市基础研究与前沿探索项目(20180103)。

摘　　要：目的探讨后颅窝肿瘤合并脑积水患者围手术期脑积水的合理处理方式及其效果。方法回顾分析241例行后颅窝肿瘤切除术患者的临床资料,其中14例患者因术后合并其他系统感染予以排除。以肿瘤切除术前是否于气管插管全麻后行腰大池引流将后颅窝肿瘤合并脑积水患者分为术前腰大池引流1(PLCFD1)组(22例)与无术前腰大池引流1(NPLCFD1)组(45例);再将227例后颅窝肿瘤患者分为术前腰大池引流2(PLCFD2)组(43例)与无术前腰大池引流2(NPLCFD2)组(184例)。分别对两组患者的临床资料进行比较分析。结果本组患者中后颅窝肿瘤合并脑积水的患者67例,术后脑积水缓解率为94.0%。PLCFD1组患者的术后早期脑积水缓解率(86.4%)明显高于NPLCFD1组患者(62.2%),差异有统计学意义(P=0.043)。PLCFD2组患者的术后颅内感染率(23.3%)明显低于NPLCFD2组患者(41.3%),差异有统计学意义(P=0.028)。PLCFD2组术后颅内感染患者的抗生素使用时间[14(10.75~20.50)d]与NPLCFD2组[17(13.25~22.75)d]相比,差异无统计学意义(P=0.134)。结论后颅窝肿瘤合并脑积水患者术前除伴明显急性颅内压增高药物治疗无效外,不建议行外科手术处理脑积水;肿瘤切除程度达次全切除及以上的患者中,术后仅很小部分患者的脑积水需进一步外科手术处理。术中、术后妥善地腰大池引流可促进后颅窝肿瘤合并脑积水患者肿瘤切除术后早期廓清炎性及血性脑脊液,从而减少术后脑积水的发生率,并且可降低后颅窝肿瘤切除术后颅内感染的发生率。Objective To investigate the reasonable treatment effect of perioperative hydrocephalus in patients with posterior fossa tumor.Methods The clinical data of 241 patients who underwent resection of posterior fossa tumors were analyzed retrospectively,of which 14 patients were excluded because of postoperative complications with other systemic infections.The patients with posterior fossa tumor complicated with hydrocephalus were divided into preoperative lumbar cistern drainage 1(PLCFD1)group(22 cases)and no preoperative lumbar cistern drainage 1(NPLCFD1)group(45 cases).227 patients with posterior fossa tumors were divided into preoperative lumbar cistern drainage 2(PLCFD2)group(43 cases)and no preoperative lumbar cistern drainage 2(NPLCFD2)group(184 cases).The clinical data of the two groups were compared and analyzed.Results In this group,67 patients with posterior cranial fossa tumor complicated with hydrocephalus,and the remission rate of hydrocephalus was 94.0%.The remission rate of early postoperative hydrocephalus in PLCFD1 group(86.4%)was significantly higher than that in NPLCFD1 group(62.2%)(P=0.043).The postoperative intracranial infection rate in PLCFD2 group(23.3%)was significantly lower than that in NPLCFD2 group(41.3%)(P=0.028).There was no significant difference in antibiotic use time between PLCFD2 group[14(10.75-20.50)d]and NPLCFD2 group[17(13.25-22.75)d](P=0.134).Conclusions Surgical treatment of hydrocephalus is not recommended in patients with posterior cranial fossa tumors complicated with hydrocephalus,except for obvious acute intracranial hypertension and ineffective drug treatment;In the patients with subtotal resection or above,only a small number of patients with hydrocephalus need further surgical treatment.Proper lumbar cistern drainage during and after operation can promote the early clearance of inflammatory and bloody cerebrospinal fluid in patients with posterior fossa tumor complicated with hydrocephalus after tumor resection,so as to reduce the incidence of postoperative hydrocephal

关 键 词：后颅窝肿瘤 脑积水 颅内感染 术前腰大池引流 

分 类 号：R739.41[医药卫生—肿瘤]