不同术式对婴儿脑积水的治疗效果对比

吉文玉 蔡宁 图柯拜 汪永新 范雁东 更·党木仁加甫

[摘要] 目的 探討脑积水患儿不同治疗术式的临床效果。 方法 选择2014年2个月～2017年3月新疆医科大学第一附属医院收治70例脑积水患儿，依据治疗方法分为第三脑室造瘘术（ETV）组（20例）、脑室-腹腔分流术（VPS）组（27例）和对照组（23例），随访6个月，统计患儿临床症状改善情况，评估不同组间和两手术组中不同年龄段患儿手术前后的发育商（DQ），CT/MRI测量两手术组术前和术后患儿的脑室宽度各指标值。 结果 ETV组、VPS组分别有18和27例患儿临床症状改善；ETV组术后6个月和VPS组术后2、6个月的DQ值与术前比较明显升高（P < 0.05），ETV组术后2、6个月的DQ值与相应VPS组比较差异明显（P < 0.05）；与术前比较，ETV组的侧脑室、三脑室和VPS组三脑室均缩小（P < 0.05）；ETV组≤1岁术后6个月DQ值，VPS组≤1岁术后2个月DQ值，均高于同期>1岁患儿（P < 0.05）。 结论 两种术式治疗脑积水患儿的临床效果显著，脑室-腹腔分流术对婴儿认知功能的改善更为明显。

[关键词] 脑积水；第三脑室底造瘘术；脑室腹腔分流术；脑认知功能

[中图分类号] R742.7 [文献标识码] A [文章编号] 1673-7210（2018）04（c）-0082-04

Comparison of therapeutic effects of different surgical methods on hydrocephalus in infants

JI Wenyu CAI Ning TU Kebai WANG Yongxin FAN Yandong Geng·Dangmurenjiafu

Department of Neurosurgery， the First Affiliated Hospital of Xinjiang Medical University， Xinjiang Uygur Autonomous Region， Urumqi 830054， China

[Abstract] Objective To explore the clinical effect of different treatment methods for children with hydrocephalus. Methods From February 2014 to March 2017， 70 cases of hydrocephalus in the First Affiliated Hospital of Xinjiang Medical University were admitted， and they were divided into ETV group （20 cases）， VPS group （27 cases） and the control group （23 cases） according to the treatment methods. After 6 months of follow-up， the improvement of clinical symptoms in children was counted， the preoperative and postoperative developmental quotients （DQ） were evaluated in children with different age among the groups and between the two surgical groups. The index values of the ventricle width in the two operation groups before and after the operation were measured by CT/MRI. Results The clinical symptoms of 18 cases in ETV group and 27 cases in VPS group were improved respectively， the DQ value of 6 months after operation in ETV group and 2， 6 months after operation in VPS group were significantly higher than those before operation （P < 0.05）. The DQ values of 2， 6 months after operation in ETV group were significantly different from those of the corresponding VPS group （P < 0.05）. Compared with the preoperative， the lateral ventricle and three ventricle of the ETV group， the three ventricle of the VPS group were reduced （P < 0.05）. The DQ values of children under 1 year old in ETV group 6 months after operation and VPS group 2 months after operation were higher than that of children older than 1 year at the same term （P < 0.05）. Conclusion The clinical effect of two kinds surgical treatment for hydrocephalus is significant， and the improvement of cognitive function is more obvious by ventriculoperitoneal shunt.

[Key words] Hydrocephalus； Endoscopic third ventriculostomy； Ventriculoperitoneal shunt； Brain cognitive function

随着内镜术器械和技术的不断完善发展，第三脑室底造瘘术（endoscopic third ventriculostomy，ETV）治疗婴幼儿脑积水的并发症降低至5%～13%，且多为一过性的，其逐渐成为除脑室-腹腔分流术（VPS）外常用治疗术式之一，给脑积水患儿带来新的希望，但对于哪种手术更加适宜目前尚无定论[1-3]。相关研究发现，认知功能障碍指标为评估脑积水患儿生活质量的主要评价指标之一[4]。采用神经内镜下ETV治疗1岁以上的非交通性脑积水患儿的效果更理想[5-6]。本研究收集新疆医科大学第一附属医院（以下简称“我院”）近年收治的70例脑积水患儿病例进行调查，拟通过术后患儿的认知功能变化来阐述两种术式的不同疗效。

1 资料与方法

1.1 一般资料

选择2014年2个月～2017年3月我院收治的70例脑积水患儿为研究对象，依据治疗方法不同将其分为ETV组（神经内镜下三脑室底造瘘术）、VPS组（脑室腹腔分流术）、对照组（未手术治疗）。……