神经内镜第三脑室底造瘘术在儿童脑室-腹腔分流管功能障碍中的应用效果  

The application effect of neuroendoscopic third ventriculostomy in children with ventriculoperitoneal shunt dysfunction

作　　者：薛萍 李昊 施伟 Xue Ping;Li Hao;Shi Wei(Department of Neurosurgery,Pediatric Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院神经外科,上海201102

出　　处：《中华神经外科杂志》2024年第9期902-907,共6页Chinese Journal of Neurosurgery

基　　金：上海市“科技创新行动计划”自然科学基金(23ZR1407900);上海市“医苑新星”青年医学人才培养资助计划[SHWSRS(2023)_062]。

摘　　要：目的探讨神经内镜第三脑室底造瘘术(ETV)在儿童脑室-腹腔(VP)分流管功能障碍中的应用效果。方法回顾性分析2016年6月至2023年6月复旦大学附属儿科医院神经外科收治的29例脑积水术后VP分流管功能障碍患儿的临床资料,所有患儿均行ETV。术后根据临床症状的改善情况,ETV成功的判定标准为术后≥3个月未再次行脑室-腹腔分流术(VPS),而ETV失败的判定标准为ETV术后3个月内再次行VPS。结果29例患儿中,男18例,女11例;ETV患儿的年龄[M(Q_(1),Q_(3))]为84.0(46.5,120.5)个月,初次行VPS的年龄[M(Q_(1),Q_(3))]为5.7(2.0,18.0)个月;诊断为梗阻性脑积水的患者有20例,交通性脑积水的患者有9例。出现分流管功能障碍的原因,3例是分流管相关感染,19例为分流管移位、头端堵塞,3例为分流管断裂,4例为裂隙脑室综合征(SVS)。29例患者的最长随访时间为90个月。至末次随访,ETV的有效率为55.2%(16/29),其中交通性脑积水患者的ETV有效比例为6/9,梗阻性脑积水患者的ETV有效率为50.0%(10/20),交通性脑积水患儿的ETV有效率较梗阻性脑积水患儿有升高的趋势,但差异无统计学意义(P>0.05),4例SVS患儿手术的成功比例仅为1/4。结论ETV在VP分流管功能障碍有一定的应用效果,可作为分流管翻修术的替代手段,尝试在任意类型分流管功能障碍患者中应用。Objective To investigate the effect of endoscopic third ventriculostomy(ETV)on the treatment of ventriculoperitoneal(VP)shunt malfunction in children.Methods The clinical data of 29 children with VP shunt dysfunction after hydrocephalus surgery who were admitted to the Neurosurgery Department of the Pediatric Hospital of Fudan University from June 2016 to June 2023 were retrospectively analyzed.All children underwent ETV.Based on the improvement of clinical symptoms after surgery,the criterion for success of ETV was that ventriculo-peritoneal shunt(VPS)was not performed again for 3 months or more after operation,while the criterion for failure of ETV was that VPS was performed again within 3 months after ETV.Results Among the 29 child patients,18 were male and 11 were female;the age of ETV child patients[M(Q_(1),Q_(3))]was 84.0(46.5,120.5)months,and the age of first VPS treatment[M(Q_(1),Q_(3))]was 5.7(2.0,18.0)months.Twenty patients were diagnosed with obstructive hydrocephalus and 9 patients with communicating hydrocephalus.The causes of shunt dysfunction were shunt-related infection in 3 cases,shunt displacement and head-end obstruction in 19 cases,shunt rupture in 3 cases,and slit ventricular syndrome(SVS)in 4 cases.The longest follow-up time of 29 child patients was 90 months.As of the last follow-up,the effective rate of ETV was 55.2%(16/29),among which the effective rate of ETV in patients with communicating hydrocephalus was 6/9,and the effective rate of ETV in child patients with obstructive hydrocephalus was 50.0%(10/20).The ETV effective rate of patients with communicating hydrocephalus tended to be higher than that of child patients with obstructive hydrocephalus,but the difference was not statistically significant(P>0.05).The success rate of surgery in 4 patients with SVS was only 1/4.Conclusion ETV has a certain application effect in VP shunt dysfunction.It can be used as an alternative to shunt revision surgery and can be applied in patients with any type of VP shunt dysfunction.

关 键 词：脑积水 自然腔道内镜手术 脑室造口术 儿童 分流管功能障碍 

分 类 号：R726.5[医药卫生—儿科]