两种手术治疗结核性脑膜脑炎并发脑积水的效果分析  

Comparison and analysis of the effectiveness of two surgical treatments for tuberculous meningoencephalitis complicated with hydrocephalus

作　　者：马宏图[1] 周建军[1] 纪文元[1] 姜婷婷 杨贇莹 梁平[1] 翟瑄[1] 李禄生[1] Ma Hongtu;Zhou Jianjun;Ji Wenyuan;Jiang Tingting;Yang Yunying;Liang Ping;Zhai Xuan;Li Lusheng(Department of Neurosurgery,Children’s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders,Chongqing 401122,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、儿童神经发育与认知障碍重庆市重点实验室,重庆401122

出　　处：《临床小儿外科杂志》2024年第9期861-865,共5页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科建设项目(国卫办医函[2013]544);重庆市科卫联合医学科研项目(2021MSXM014)。

摘　　要：目的评价皮下隧道长程脑室外引流术(long tunnelled external ventricular drainage, LTEVD)与Ommaya囊植入外引流术治疗结核性脑膜脑炎并发脑积水的临床疗效。方法回顾性分析2016年1月至2022年3月在重庆医科大学附属儿童医院接受手术治疗的结核性脑膜脑炎并发脑积水患儿临床资料。根据手术方式将患儿分为Ommaya囊植入外引流术组(Ommaya囊组)、LTEVD组。收集两组手术前后脑脊液指标, 脑积水变化, 最终是否行脑室-腹腔分流术(ventriculoperitoneal shunt, VPS), 智力、语言和行为发育评分, 以及有无继发感染或脑脊液漏等并发症。结果两组术前和术后各时间点脑脊液白细胞数、蛋白含量和葡萄糖水平差异无统计学意义(P>0.05), 但术后10 d、20 d及30 d, LTEVD组脑脊液单核细胞比例和氯化物水平改善情况优于Ommaya囊组(P<0.05)。Ommaya囊组有6例(75%)最终行VPS, LTEVD组有5例(45%)行VPS, 差异无统计学意义(P>0.05)。在0~6岁患儿中, LTEVD组智力、语言、行为等发育改善情况较Ommaya囊组显著(P<0.05)。两组均无一例引流管阻塞或脑脊液漏发生, Ommaya囊组有4例(50.00%)术后继发感染, LTEVD组无一例继发感染, 差异有统计学意义(P<0.05)。结论 LTEVD治疗结核性脑膜脑炎并发脑积水, 在改善脑脊液性质和促进0~6岁患儿智力、语言、行为发育上效果显著, 术后继发感染的风险低于Ommaya囊植入外引流术。Objective To evaluate the clinical efficacy of long tunnelled external ventricular drainage(LTEVD)versus Ommaya reservoir implantation and external drainage in treating tuberculous meningoencephalitis complicated with hydrocephalus.Methods A retrospective analysis of clinical data from children treated surgically for tuberculous meningoencephalitis complicated with hydrocephalus at Children’s Hospital of Chongqing Medical University from January 2016 to March 2022.Patients were divided into the Ommaya reservoir implantation and external drainage group(Ommaya reservoir group)and LTEVD group based on the surgical method.Pre-and post-operative cerebrospinal fluid indicators,changes in hydrocephalus,whether ventriculoperitoneal shunt(VPS)was ultimately performed,scores of intellectual,language,and behavioral development,and the occurrence of secondary infection or cerebrospinal fluid leakage were collected and statistically analyzed.Results No significant differences were found between the two groups in pre-and post-operative cerebrospinal fluid white blood cell count,protein content,and glucose levels(P>0.05).However,at post-operative days 10,20,and 30,the LTEVD group showed better improvement in cerebrospinal fluid monocyte ratio and chloride levels compared to the Ommaya reservoir group(P<0.05).Six cases(75%)in the Ommaya reservoir group and five cases(45%)in the LTEVD group ultimately underwent VPS,with no significant difference(P>0.05).Among children aged 0 to 6 years,the LTEVD group showed significant improvements in intellectual,language,and behavioral development compared to the Ommaya reservoir group(P<0.05).Neither group experienced drainage tube blockage or cerebrospinal fluid leakage,but 4 cases(50.00%)in the Ommaya reservoir group developed post-operative secondary infections,while no such infections occurred in the LTEVD group(P<0.05).Conclusions LTEVD is significantly effective in improving cerebrospinal fluid properties and promoting intellectual,language,and behavioral development in children aged

关 键 词：结核性脑膜脑炎 脑积水 脑室外引流术 感染 

分 类 号：R65[医药卫生—外科学]