IGCTs所致梗阻性脑积水远期分流装置移除的可行性探讨  

Feasibility of removal of long-term shunt device for obstructive hydrocephalus caused by IGCTs

作　　者：王立 李禄生[1] 梁平[1] 翟瑄[1] 周渝冬[1] 纪文元[1] 周建军[1] 朱涛 WANG Li;LI Lu-sheng;LIANG Ping(Department of Neurosurgery,Affiliated Children s Hospital,Chongqing Medical University,Ministry of Education Key Laboratory of Child Developmental&Disorders,Chongqing Key Laboratory of Pediatrics,China International Science&Technology cooperation Base of Child Development&Critical Disorders,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院神经外科国家儿童健康与疾病临床医学研究中心儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室 [2]西北妇女儿童医院神经外科 [3]酉阳县人民医院普通外科

出　　处：《临床神经外科杂志》2023年第2期216-218,223,共4页Journal of Clinical Neurosurgery

基　　金：重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0143);重庆市卫健委科卫联合科研项目重点项目(2023ZDXM023)。

摘　　要：目的探讨可调压抗虹吸分流装置在颅内生殖细胞肿瘤(IGCTs)所致脑积水治疗中的意义及远期移除分流装置的可行性。方法重庆医科大学附属儿童医院神经外科2013年1月—2017年12月间42例拟诊为IGCTs伴梗阻性脑积水患儿,均采用可调压抗虹吸分流装置行脑室腹腔分流术(VPS),术后予以行诊断性化疗;回顾性分析其中20例在肿瘤达到完全缓解后行分流装置移除术的诊疗过程。结果行VPS术后,20例患儿的高颅压症状均获得显著缓解,无症状加重者。术后复查CT或MRI显示脑室系统正常;眼底检查未见明显损害情况,术前视力模糊者术后视力逐渐恢复正常,现视力与同龄人相仿。治疗过程中未见分流装置堵塞、感染病例,予以诊断性化疗,肿瘤获得完全缓解,6~12个月后行分流装置夹闭或移除术,随访36~92个月,20例患者均未出现颅内高压症状。至随访结束时均已入学,生活质量未见明显影响。结论IGCTs所致梗阻性脑积水行VPS早期可以快速降低颅压,缓解颅内高压症状,降低颅内压持续升高而发生脑疝的风险。术后经诊断性化疗,在肿瘤获得完全缓解后,可行分流装置移除术,降低分流装置堵塞、感染、断裂等风险,避免患儿终生留置体内分流装置,可有效提高患儿生活质量。Objective To explore the significance of adjustable pressure anti-siphon shunt device in the treatment of hydrocephalus caused by intracranial germ cell tumor(IGCTs)and the feasibility of long-term removal of shunt device.Methods From January 2013 to December 2017,42 patients suspected of IGCTs with obstructive hydrocephalus admitted to the Department of Neurosurgery,the Affiliated Children s Hospital of Chongqing Medical University were treated with ventriculoperitoneal shunt(VPS)and diagnostic chemotherapy.Among them,20 cases were treated with shunt device after the tumor reached complete remission.The diagnosis and treatment of the 20 cases were analyzed retrospectively.Results After VPS,the symptoms of high intracranial pressure in 20 children were significantly relieved,and the symptoms were not aggravated.Postoperative CT or MRI showed that the ventricular system was normal,fundus examination showed no obvious damage,and the postoperative visual acuity of children with blurred vision gradually returned to normal.Now their visual acuity was similar to that of their peers.No case of obstruction or infection of shunt device was found during the treatment.Diagnostic chemotherapy was given and the tumor was completely relieved.Half a year to 1 year later,the shunt device was clipped or removed.During the follow-up of 36 to 92 months,20 children had no symptoms of intracranial hypertension.They were enrolled at the end of follow-up,and there was no significant effect on the quality of life.Conclusions VPS in the early stage of IGCTs-induced obstructive hydrocephalus can quickly reduce intracranial pressure,relieve the symptoms of intracranial hypertension and reduce the risk of cerebral hernia caused by continuous increase of intracranial pressure.After diagnostic chemotherapy and complete remission of the tumor,it is feasible to remove the shunt device,reduce the risk of blockage,infection and rupture of the shunt device,and avoid indwelling the shunt device lifelong,which can effectively improve the quality of

关 键 词：可调压抗虹吸分流装置 颅内生殖细胞瘤 梗阻性脑积水 脑室腹腔分流术 儿童 

分 类 号：R739.41[医药卫生—肿瘤]