儿童髓母细胞瘤术后持续性脑积水预测标准的建立及验证  

Construction and validation of predictive criteria for postoperative persistent hydrocephalus in pediatric medulloblastoma

作　　者：任思康 周文韬 安旭 牛嘉豪 田永吉[1] REN Sikang;ZHOU Wentao;AN Xu;NIU Jiahao;TIAN Yongji(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《临床神经外科杂志》2025年第1期20-25,共6页Journal of Clinical Neurosurgery

基　　金：首都卫生发展科研专项项目(2018-2-1073)。

摘　　要：目的建立儿童髓母细胞瘤术后持续性脑积水(PPH)的预测标准,以筛选出发生概率较低的患儿,进行精准治疗,避免不必要的肿瘤切除术前脑室腹腔分流术,提高患儿术后生活质量。方法依据加拿大脑积水术前预测标准(mCPPRH),前瞻性纳入2019年12月—2023年3月在首都医科大学附属北京天坛医院神经外科小儿病区第一次接受手术治疗的24例髓母细胞瘤患儿,术后随访以PPH的发生为主要观察指标。结果所有患儿均采用联合手术治疗策略(即术中侧脑室穿刺Ommaya囊植入+肿瘤切除术),术后随访除1例于术后1年肿瘤播散致死亡外,其余患儿均未出现PPH。结论通过前瞻性入组髓母细胞瘤合并脑积水的患儿,重点关注年龄、脑积水严重程度及肿瘤有无播散,进行联合手术并长期随访,本研究初步建立并验证了儿童髓母细胞瘤PPH的预测标准,较为简单、实用,有待于后续更大样本量的临床验证。Objective To establish predictive criteria for post-operative persistent hydrocephalus(PPH)following medulloblastoma surgery in children,in order to identify children with a low probability of occurrence for accurate treatment,avoid unnecessary ventricular-peritoneal shunt before tumor resection,and improve the postoperative quality of life for children.Methods According to the modified Canadian Preoperative Prediction Rule for Hydrocephalus(mCPPRH),a total of 24 children with medulloblastoma who underwent surgery for the first time in the Pediatric Ward of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from December 2019 to March 2023 were included.The occurrence of PPH was used as the main observation index during postoperative follow-up.Results All children were treated with combined surgical strategy(intraoperative Ommaya reservoir implantation by lateral ventricle puncture+tumor resection).No PPH occurred in all the children during postoperative follow-up except for 1 patient who died of tumor spread 1 year after surgery.Conclusions Through prospective enrollment of children with medulloblastoma complicated with hydrocephalus,focusing on age,severity of hydrocephalus and metastasis,combined operation and long-term follow-up,the prediction criteria for PPH of pediatric medulloblastoma was preliminarily established and verified,which is relatively simple and practical,and needs to be clinically verified by a larger sample size in the future.

关 键 词：儿童髓母细胞瘤 术后持续性脑积水 加拿大脑积水术前预测标准 OMMAYA囊 联合手术 

分 类 号：R739.41[医药卫生—肿瘤]