内镜第三脑室底造瘘术在儿童后颅窝肿瘤所致梗阻性脑积水中的应用分析  

Analysis of application of endoscopic third ventriculostomy in obstructive hydrocephalus caused by posterior fossa tumors in children

作　　者：高俜娉[1] 杨波[1] 宋云海 夏泽阳 鲍南[1] Gao Pingping;Yang Bo;Song Yunhai;Xia Zeyang;Bao Nan(Department of Neurosurgery,Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心神经外科,上海200127

出　　处：《中华神经外科杂志》2023年第6期572-576,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨内镜第三脑室底造瘘术(ETV)在儿童后颅窝肿瘤所致梗阻性脑积水中的应用效果及并发症情况.方法回顾性分析2013年9月至2021年9月上海交通大学医学院附属上海儿童医学中心神经外科收治的93例后颅窝肿瘤患儿的临床资料.所有患儿均存在急性梗阻性脑积水所致的颅高压症状,并于二期肿瘤切除术前行一期ETV.分析ETV的术后疗效、并发症发生率,以及肿瘤切除术后的脑积水复发率.结果98.9%(92/93)的患儿ETV成功实施,且术后颅高压症状缓解,1例患儿因术中出血导致行ETV失败.术后并发症(1例发生颅内感染)的发生率为1.1%(1/92),经抗感染治疗后好转.肿瘤切除术后的脑积水复发率为6.5%(6/92),经再次手术置入脑室-腹腔分流管,脑积水均获得缓解.结论小儿后颅窝肿瘤合并梗阻性脑积水需急诊缓解颅高压时应首选ETV,其并发症少,且肿瘤切除术后的脑积水复发率低.Objective To investigate the therapeutic effect and complications of endoscopic third ventriculostomy(ETV)in children with obstructive hydrocephalus caused by posterior fossa tumors.Methods A retrospective study was conducted on the clinical data of 92 children with posterior fossa tumors admitted to the Department of Neurosurgery,Shanghai Children's Medical Center Afiliated to Shanghai Jiaotong University School of Medicine from September 2013 to September 2021.All children had symptoms of intracranial hypertension caused by obstructive hydrocephalus and procedures was performed in two stages(ETV first and tumor resection second).Postoperative efficacy and incidence of complications of ETV and recurrence rate of hydrocephalus post tumor resection were determined.Results ETV was successfully completed in 98.9%(92/93)of all patients and the symptoms of intracranial hypertension were relieved after ETV.ETV failed in 1 case due to intracranial bleeding.The symptoms of intracranial hypertension were relieved after ETV in all cases.There was 1 case of intracranial infection after operation,which was cured by anti-infection therapy.The complication rate was 1.1%(1/92).The recurrence rate of hydrocephalus was 6.5%(6/92).In all cases of current hydrocephalus,the hydrocephalus was relieved after reoperation and placement of a ventriculoperitoneal shunt.Conclusion For children with posterior fossa tumors complicated with obstructive hydrocephalus in need of emergency relief of intracranial hypertension,ETV treatment can relieve the symptoms of intracranial hypertension in time,with few complications and a low recurrence rate of hydrocephalus after tumor resection.

关 键 词：脑积水 治疗结果 手术后并发症 内镜第三脑室底造瘘术 脑肿瘤 颅窝 后 

分 类 号：R739.41[医药卫生—肿瘤]