儿童脑积水可调压分流管分流术后硬膜下积液/血肿的临床分析  

Clinical feature analysis of subdural effusion/hematoma after shunt use of adjustable valves in children with hydrocephalus

作　　者：汤伟 何远志 杜浩 Tang Wei;He Yuanzhi;Du Hao(Department of Neurosurgery,Wuhan Children′s Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院神经外科,武汉430016

出　　处：《中华实用儿科临床杂志》2022年第20期1559-1562,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析儿童脑积水可调压分流管分流术后硬膜下积液/血肿(SEHS)的临床资料,为术后随访提供参考。方法回顾性研究。2017年8月至2021年9月于华中科技大学同济医学院附属武汉儿童医院神经外科使用可调压分流管治疗脑积水患儿共102例,其中发生SEHS 16例。16例患儿中,男11例,女5例;年龄3个月~13岁,平均2.5岁;总结这些患儿的年龄、临床表现、SEHS出现时间、治疗方式(单纯调压或联合钻孔引流)、预后情况等。调压治疗为每次调高10~20 mmH2O(1 mmH2O=0.0098 kPa),间隔2~4周复查,如复查SEHS未减少,则建议调压联合钻孔引流治疗。结果16例患儿中,>3岁3例,≤3岁13例。11例为单纯调高压力治疗,5例需调高压力联合钻孔引流,且年龄均≤3岁。2例出现症状:1例为呕吐,另1例为头及肢体抖动;14例无症状。出现SEHS的时间距离分流手术时间:≤1个月者5例,均通过单纯调高压力治愈;>1~3个月者5例,2例需联合钻孔引流;>3~6个月者3例,1例需联合钻孔引流;>6个月者3例,2例需联合钻孔引流;5例需联合钻孔引流的病例SEHS出现时间距离分流手术的时间分别为1个月21 d、2个月7 d、4.5个月、7.5个月、25.0个月。出现SEHS的时间距离最近1次复查未出现SEHS的时间:≤1个月者7例,均通过单纯调高压力治愈;>1~3个月者5例,3例需钻孔联合调高压力治愈;>3个月4例,2例需钻孔引流联合调高压力治疗;需联合钻孔引流的病例SEHS出现的时间距离最近1次复查未出现SEHS时间分别为1个月14 d、2.0个月、3.0个月、7.0个月及8.0个月。16例患儿中因调压阀故障2例,其余病例均治愈。6例为单侧SEHS,SEHS量为11~75 mL,平均39.0 mL,均调高压力治愈;10例为双侧,双侧SEHS量共23~380 mL,平均158.2 mL。6例单侧SEHS中,5例为引流管置入侧。结论儿童脑积水可调压分流管分流术后出现SEHS大多无症状,较少引起临床症状;SEHS大多发生在术后6个月以内,尤以3个月�Objective To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS)with adjustable valves,and to provide reference for postoperative follow-up.Methods A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery,Wuhan Children′s Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively.There were 16 cases with SEHS,11 of whom were male and 5 were female.The age ranged from 3 months to 13 years(median:2.5 years).The age,clinical manifestations,the time of SEHS occurrence,treatment methods(pressure regulation only or combined with drilling and drainage),and prognosis of the patients were analyzed.The pressure adjustment treatment was to increase the by 10-20 mmH2O(1 mmH2O=0.0098 kPa)each time and the patients were followed up 2-4 weeks after the adjustment.If SEHS didn′t improve according to the follow-up results,pressure regulation combined with drilling and drainage was recommended.Results Of the 16 patients with SEHS,3 cases were over 3 years old,and the other 13 cases were 3 years old or below.Eleven cases were treated by pressure regulation only,and 5 cases who were all aged≤3 years received pressure regulation combined with drilling and drainage.Symptoms occurred in 2 patients,including vomiting in 1 case,and head and limb shaking in the other case.Fourteen cases were asymptomatic.The time from shunt operation to the occurrence of SEHS was≤1 month in 5 cases,who were all cured by pressure regulation only.SEHS occurred in 5 cases>1-3 months after shunt surgery,and 2 cases of them were treated by pressure regulation combined with dri-lling and drainage.Three cases had SEHS>3-6 months after shunt surgery,and 1 case of them was treated by pressure regulation combined with drilling and drainage.SEHS occurred in 3 cases more than 6 months after shunt surgery,and 1 case of them was treated by

关 键 词：脑积水 可调压分流管 硬膜下积液 硬膜下血肿 儿童 

分 类 号：R742.7[医药卫生—神经病学与精神病学]