不同分型儿童外侧裂蛛网膜囊肿的临床分析  

Clinical analysis of different types of intracranial sylvian fissure arachnoid cysts in children

作　　者：赵恒 王勤华[1] 赵阳[1] 梁壮壮 马杰[1] Zhao Heng;Wang Qinhua;Zhao Yang;Liang Zhuangzhuang;Ma Jie(Department of Pediatric Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿神经外科,上海200092

出　　处：《中华神经外科杂志》2022年第7期658-663,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨不同分型儿童外侧裂蛛网膜囊肿的临床特点及预后的影响因素。方法回顾性分析2015年1月至2020年1月上海交通大学医学院附属新华医院小儿神经外科收治的145例外侧裂蛛网膜囊肿患儿的临床资料。根据Galassi分型将囊肿分为GalassiⅡ型(78例)和Ⅲ型(67例)。其中56例行显微镜下囊肿剥离开窗术,89例行神经内镜下囊肿剥离开窗术。术后对患儿进行临床和影像学随访,预后评价采用Kandenwein症状评估方法。比较不同类型患儿的临床特点及预后,并进一步采用多因素logistic回归分析法分析影响患儿预后的因素。结果145例患儿的手术均成功,围手术期无死亡病例。术后共26例(17.9%)患儿出现手术相关并发症,其中硬膜下积液13例、硬膜下血肿10例、脑脊液漏1例、急性脑积水2例。145例患儿的随访时间为(60.1±15.7)个月(24~83个月)。末次随访显示,预后良好125例(86.2%),预后不良20例(13.8%)。GalassiⅡ型组和Ⅲ型组患儿的年龄、性别、囊肿部位、早产及手术方式比较差异均无统计学意义(均P>0.05),而术前合并脑积水、术后并发症、Kandenwein症状评估以及术前、后囊肿最大径的差异均有统计学意义(均P<0.05)。Ⅲ型囊肿术前常合并脑积水,术后易出现并发症。同时,Ⅲ型囊肿术前、后囊肿的最大径均大于Ⅱ型囊肿。多因素logistic回归分析显示,Galassi分型是影响患儿预后的独立因素(OR=9.35,95%CI:1.74~50.19,P=0.009)。结论GalassiⅡ型和Ⅲ型儿童外侧裂蛛网膜囊肿的临床特点不同,Ⅲ型囊肿患儿的整体预后差于Ⅱ型囊肿;外侧裂珠网膜囊肿患儿的预后可能与Galassi分型有关。Objective To investigate the clinical characteristics and prognostic factors of different types of intracranial arachnoid cysts in children.Methods A retrospective analysis was conducted on the clinical data of 145 children with intracranial sylvian arachnoid cysts admitted to the Department of Pediatric Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020.According to the Galassi classification,those cysts were divided into Galassi typeⅡ(78 cases)and typeⅢ(67 cases).Among them,56 cases underwent cyst dissection and fenestration under microscope,and 89 cases underwent neuroendoscopic cyst dissection and fenestration.Postoperative clinical and imaging follow-up was performed on the children,and the Kandenwein clinical symptom assessment method was used to evaluate the outcomes.The clinical characteristics and outcomes of different types of children were compared,and the factors affecting the prognosis of children were further analyzed by multivariate logistic regression.Results All 145 cases underwent successful operation,and there were no perioperative deaths.A total of 26 children(17.9%)had surgery-related complications after surgery,including 13 cases of subdural effusion,10 cases of subdural hematoma,1 case of cerebrospinal fluid leakage,2 cases of acute hydrocephalus.The follow-up time of 145 children was 60.1±15.7 months(24-83 months).The last follow-up showed favorable outcome in 125 cases(86.2%)and poor outcome in 20 cases(13.8%).There was no significant difference in age,gender,cyst location,preterm birth,or operation method between Galassi typeⅡgroup and typeⅢgroup(all P>0.05),while significant inter-group differences were indicated in preoperative hydrocephalus,postoperative complications,Kandenwein symptom assessment,as well as preoperative and postoperative maximum diameters of the cyst(all P<0.05).TypeⅢcysts were often associated with hydrocephalus before surgery,and postoperative complications were prone to occur.At

关 键 词：蛛网膜囊肿 儿童 预后 外侧裂 临床分型 

分 类 号：R726.5[医药卫生—儿科]