婴幼儿脑室-腹腔分流术后裂隙脑室综合征的临床特点及其影响因素分析  

Clinical characteristics and influencing factors of slit ventricle syndrome after ventriculoperitoneal shunt in infants and young children

作　　者：杨佳利 马云富[1] 杨继学 王迎宾[1] 冯孟昭 Yang Jiali;Ma Yunfu;Yang Jixue;Wang Yingbin;Feng Mengzhao(Department of Neurosurgery,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2022年第7期683-687,共5页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划 (LHGJ20190373)。

摘　　要：目的探讨婴幼儿脑室-腹腔分流术后裂隙脑室综合征的临床特点及其影响因素。方法回顾性分析2013年1月至2018年12月郑州大学第三附属医院神经外科行脑室-腹腔分流术治疗的497例脑积水患儿(年龄≤3岁)的临床资料。根据术后是否发生裂隙脑室综合征分为裂隙脑室综合征组和无裂隙脑室综合征组。进一步采用单因素分析和多因素logistic回归分析法(进入法)判断影响患儿术后出现裂隙脑室综合征的临床因素。结果497例患儿中,28例(5.6%)诊断为裂隙脑室综合征,发生时间[M(Q_(1),Q_(3))]为术后3.8(2.8,5.5)年。28例患儿中,临床表现为间断性头痛28例,呕吐22例,发热7例,嗜睡4例,肌无力2例,肢体抽搐及视盘水肿各1例。裂隙脑室综合征组(28例)与无裂隙脑室综合征组(469例)比较,年龄、早产史、病因、脑积水的严重程度以及分流管类型的差异均存在统计学意义(均P<0.05);而性别和手术入路的差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,年龄小(OR=0.83,95%CI:0.70~0.99)、有早产史(OR=4.62,95%CI:1.81~11.80)、重度脑积水(OR=6.31,95%CI:2.34~17.01)和采用定压分流管(OR=4.26,95%CI:1.70~10.71)是婴幼儿脑室-腹腔分流术后发生裂隙脑室综合征的独立危险因素(均P<0.05)。结论婴幼儿脑积水脑室-腹腔分流术后裂隙脑室综合征的发生率较高,常见临床表现为间断性头痛和呕吐。年龄越小、有早产史、重度脑积水及采用定压分流管的脑积水患儿行脑室-腹腔分流术后更易发生裂隙脑室综合征。Objective To investigate the clinical characteristics and influencing factors of slit ventricle syndrome(SVS)after ventriculoperitoneal shunt(VPS)in infants and young children.Methods The clinical data of 497 infants and young children(≤3 years old)with hydrocephalus who were treated by VPS at the Department of Neurosurgery,the Third Affiliated Hospital of Zhengzhou University from January 2013 to December 2018 were retrospectively analyzed.According to the occurrence of SVS,the patients were divided into the SVS group and non-SVS group.Univariate analysis and multivariate logistic regression analysis(Enter)were further used to determine the clinical factors affecting the postoperative occurrence of SVS.Results Of the 497 children,28(5.6%)were diagnosed with SVS,and the onset time[M(Q_(1),Q_(3))]was 3.8(2.8,5.5)years after surgery.Among the 28 children,the clinical manifestations were intermittent headache in 28 cases,vomiting in 22 cases,fever in 7 cases,drowsiness in 4 cases,muscle weakness in 2 cases,limb convulsion in 1 case and papilledema in 1 case.There were statistically significant differences in age,history of premature birth,etiology,severity of hydrocephalus and shunt tube type between the SVS group(n=28)and the non-SVS group(n=469)(all P<0.05).There was no significant difference in gender or surgical approach between the groups(both P>0.05).Multivariate logistic regression analysis showed that young age(OR=0.83,95%CI:0.70-0.99),history of premature birth(OR=4.62,95%CI:1.81-11.80),severe hydrocephalus(OR=6.31,95%CI:2.34-17.01)and the use of constant pressure shunt tube(OR=4.26,95%CI:1.70-10.71)were independent risk factors for SVS after VPS(all P<0.05).Conclusions Infants and young children with hydrocephalus after VPS have a high incidence of SVS,and the common clinical manifestations are intermittent headache and vomiting.Children with younger age,history of premature birth,severe hydrocephalus as well as constant pressure shunts are more likely to develop SVS after VPS.

关 键 词：脑积水 儿童 脑室腹膜分流术 裂隙脑室综合征 影响因素分析 

分 类 号：R726.5[医药卫生—儿科]