JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(01):0.
婴幼儿阻塞性脑积水两种手术方式的疗效比较
- Title:
- Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.
- Keywords:
- Hydrocephalus; Surgical procedures; Operative; Infant
- 摘要:
- 目的回顾性分析2005年以来上海交通大学医学院附属新华医院收治的2岁以下阻塞性脑积水患儿的临床资料，比较神经内镜下第三脑室底造瘘术（ETV）与传统的脑室腹腔分流术（VP shunt）治疗婴儿阻塞性脑积水的疗效。 方法 2005年以来作者收治36例阻塞性脑积水患儿，均为单纯导水管狭窄，根据手术方式分为ETV治疗组和VP shunt治疗组，比较两组围手术期情况、影像学检查结果以及临床症状，并进行统计学分析。结果 36例中，ETV治疗组20例；VP shunt治疗组16例。均手术顺利，无术中并发症。ETV组有2例术后当天出现癫痫，考虑为间脑发作，经药物治疗后未再复发；1例出现脑室内出血，1例出现硬膜下出血，均予药物治疗后吸收；1例术后第10天出现伤口渗液、脑脊液漏，改行VP shunt治疗后痊愈；ETV组成功率95%，再手术率5%，近期并发症发生率25%，无远期并发症。VP shunt组16例中，1例术后第10天出现头端伤口感染，予抗感染治疗后好转，2个月后出现颅内感染，行拔管术，抗感染治疗好转后重新置管；1例术后5个月后复发脑积水，行ETV后好转；1例转流功能障碍，行再次VP shunt后好转；1例分流管头端脱出，行再次VP shunt后好转，手术总成功率75%，再手术率25%，近期并发症发生率6.25%，远期并发症发生率18.75%。结论2岁以下婴幼儿阻塞性脑积水ETV与分流治疗对比，ETV近期并发症的发生率高于VP shunt，长期随访未出现新的神经功能障碍，远期并发症明显少于VP shunt，具有推广价值。
- Abstract:
- ObjectiveWe analyzed those infant patients with obstructive hydrocephalus since 2005 in our department. The postoperative outcome was compared by followup data such as images and clinical finding. Methods 36 subjects were included in the study, and divided as ETV group and VP shunt group depend on the surgical procedure. We retrospectively analyzed the followup data such as images and clinical finding of the obstructive patients younger than 2 years old in our department since 2005, and compare the successful rate and complication rate.Results Among 36 patients, 20 of them were treated with ETV and 16 of them were treated with VP shunt. In ETV group, 1 infant did not get improved and suffered from CSF leakage after operation, and VP shunt was performed to avoid intracranial infection. Intraventricular hemorrhage occurred in 1 and was treated with medicine. 1 child presented with subdural hemotoma and recovered. 2 children had seizure after surgery was treated with medicine without recurrence. The complications were transient and mostly recovered, no late complication. No severe complication occurred. The early complication rate was 25% in ETV group and successful rate was 95%. In VP shunt group, 1 child presented with incranial infection, the ventricular catheter was removed to treat the infection. VP shunt was performed again after the infection was controlled. 1 case did not improve and performed ETV to control the hydrocephalus. 1 case presented with shunt malfunction and was treated with repeated VP shunt one year after the first surgery. 1 case suffered from the ventricular catheter migration and was treated with the repeated VP shunt 1 year after operation. In VP shunt group, the overall successful rate was 75%, the complication rate was 25%. Among them, the early complication rate was 6.25% , the late complication rate was 18.75%, all the complications need surgery precedure. Conclusions It could be concluded that ETV is the most often performed and reported neuroendoscopic procedure in the treatment of hydrocephalus caused by pure aqueductal stenosis. Compare to VP shunt group,ETV group had no mortaliity, lower failure rate, higher early complication rate but transient and mild. No more neurologic defect occured by followup in ETV group. In this group of infants, ETV is a significant alternative to ventricular shunt placement.
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备注/Memo
作者单位：上海交通大学医学院附属新华医院小儿神经外科（200092）,通讯作者： 马杰，Email:majie365@hotmail.com