Zhang Yi,Shen Chun,Xue Ping,et al.Effect of prenatal examination and surgical strategy for shunt outcome in neonatal hydrocephalus[J].Journal of Clinical Pediatric Surgery,2022,21(09):815-819.[doi:10.3760/cma.j.cn101785-202204092-004]
产前检查及手术策略对新生儿脑积水分流障碍的影响研究
- Title:
- Effect of prenatal examination and surgical strategy for shunt outcome in neonatal hydrocephalus
- 摘要:
- 目的 以接受新生儿脑积水脑室腹腔分流术治疗的患者为研究对象，探讨产前检查及手术策略与新生儿脑积水分流障碍发生的关系，寻找相关风险因素。方法 将2013年1月至2020年8月复旦大学附属儿科医院因新生儿期脑积水行脑室腹腔分流术的53例患儿纳入研究。按照是否发生分流障碍将患儿分为无分流障碍组（n=37）和分流障碍组（n=16），比较两组患儿一般资料（含母亲资料）、母亲妊娠期合并症资料以及胎儿合并症、脑积水病因、影像学特点、手术治疗情况。通过单因素、多因素及生存曲线分析，总结影响新生儿脑积水治疗结局的相关因素。结果 53例患儿平均随访时间4年6个月（2年3个月至9年4个月），其中16例发生分流障碍。单因素分析结果显示，感染后脑积水（P=0.04）、脑脊液蛋白水平高（P=0.002）的患儿分流障碍发生率高。采用额角穿刺（P=0.04）和使用Strata分流阀（P=0.02）的患儿分流障碍发生率低。先天性脑积水常在产前检查过程中被发现（6/8），患儿母亲多为剖宫产（6/8）。而继发性脑积水（出血及感染后发生）产前检查中胎儿多无异常（35/37），但患儿母亲妊娠合并症多，且患儿母亲多为顺产（34/36）。多因素分析结果显示，术前脑脊液蛋白水平（OR：2.198，95%CI：1.015~4.758，P=0.04）、脑室端入点（OR：3.600，95%CI：1.257~7.088，P=0.03）是导致分流障碍发生的风险因素。结论 新生儿脑积水中，先天性脑积水多见于足月分娩儿，产前诊断率高，分流障碍发生率低；继发性脑积水多见于早产儿，产前妊娠合并症多，分流障碍发生率高。采用额角穿刺可提高新生儿脑积水脑室腹腔分流术的成功率。
- Abstract:
- Objective To explore the relationship of prenatal examinations, surgical strategies and the occurrences of shunt dysfunction in children with neonatal hydrocephalus undergoing ventriculoperitoneal shunt (VPS) and identify the related risk factors.Methods From January 2013 to August 2020, 53 children undergoing VPS due to neonatal hydrocephalus were recruited.They were divided into two groups according to the occurrence of shunt dysfunction.General profiles of pregnant women, complications during pregnancy, fetal complications, causes, imaging features and surgical approaches were compared between two groups.Through univariate, multivariate and survival curve analyses, the related influencing factors of therapeutic outcomes were summarized.Results During a mean follow-up of 54(27-112) months, 16 cases developed shunt dysfunction.Univariate analysis indicated that children with post-hemorrhagic/infected hydrocephalus (P=0.04) and those with a high level of cerebrospinal fluid protein had a higher incidence of shunt dysfunction (P=0.002).And children with frontal puncture (P=0.04) and strata shunt valve (P=0.02) had a lower incidence of shunt dysfunction.Congenital hydrocephalus was detected during prenatal examinations (6/8) and cesarean section predominated (6/8).For secondary hydrocephalus (after hemorrhage & infection), no fetal abnormality (35/37) was detected during prenatal examinations.However, there were many pregnancy complications and most of them had vaginal delivery (34/36).Multivariate analysis showed that preoperative protein level of cerebrospinal fluid (OR:2.198, 95%CI:1.015-4.758, P=0.04) and ventricular entry site (OR:3.600, 95%CI:1.257-7.088, P=0.03) were risk factors for the occurrence of shunt dysfunction.Conclusion In neonatal hydrocephalus, congenital hydrocephalus is more common in term delivery with a high prenatal diagnostic rate and a low incidence of shunt dysfunction.Secondary hydrocephalus is more likely to be premature, with more complications of prenatal pregnancy and a high incidence of shunt dysfunction.The use of frontal puncture can improve the success rate of ventriculoperitoneal shunt in neonatal hydrocephalus.
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备注/Memo
收稿日期:2022-04-29。
基金项目:国家自然科学基金（82101810）
通讯作者:李昊,E-mail:li_hao@fudan.edu.cn