Efficiency evaluation of adjustable shunt drainage in ventriculoperitoneal drainage within 6 months for children with congenital hydrocephalus
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摘要:目的 探讨可调控性分流管引流在小儿先天性脑积水6个月内行脑室-腹腔引流术(VPS)中的效能。方法 将89例先天性脑积水患儿随机分为VPS组45例(行脑室-腹腔引流术，可调控性分流管)与第三脑室底造瘘术(ETV)组44例(行神经内镜下第三脑室底造瘘术)。比较2组患儿的治疗效果、预后情况等。结果 VPS组术后疗效显著优于ETV组(P < 0.05)。VPS组术中出血量显著高于ETV组(P < 0.05), 手术成功例数及术后感染例数显著多于ETV组(P < 0.05)。ETV组、VPS组术后6个月脑室额角宽度、第三脑室宽度均显著优于术前(P < 0.05); VPS组术后6个月脑室额角宽度、第三脑室宽度水平优于ETV组，但差异无统计学意义(P>0.05)。术后6个月, VPS组精细运动行为、大运动行为、语言能力、适应能力、个人-社会行为、DQ值评分均显著低高于ETV组(P < 0.05)。2组1岁以下与1~2岁患儿术后2周的DQ比较，差异无统计学意义(P>0.05); 2组术后9周、6个月的1岁以下患儿DQ均显著高于同组1~2岁患儿(P < 0.05)。结论 VPS术中应用可调控性分流管能有效提高治疗效果，显著改善患儿预后及认知功能。Abstract:Objective To investigate the efficiency of adjustable shunt drainage in ventriculoperitoneal drainage (VPS) within 6 months for children with congenital hydrocephalus.Methods Totally 89 children with congenital hydrocephalus were randomly divided into VPS group (n=45, treated with VPS by adjustable shunt) and endoscopic third ventriculostomy (ETV) group (n=44, treated with endoscopic third ventriculostomy). The therapeutic effect and prognosis of the two groups were compared.Results The curative effect of VPS group was significantly better than that of ETV group (P < 0.05). The amount of bleeding during operation in VPS group was significantly more than that in ETV group (P < 0.05), and the number of children with successful operation and with infection after operation were significantly higher than those in ETV group (P < 0.05). The frontal angle width and the third ventricle width in ETV group and VPS group at 6 months after operation were significantly better than those before operation (P < 0.05), and the frontal angle width and the third ventricle width in VPS group at 6 months after operation were better than those in ETV group, but there were no significant differences (P>0.05). Six months after operation, the scores of fine motor behavior, large motor behavior, language ability, adaptability, personal-social behavior and DQ value in VPS group were significantly higher than those in ETV group (P < 0.05). There was no significant difference in DQ at 2 weeks after operation between children below 1 year of age and with 1 to 2 years of age in both groups (P>0.05). DQ of children with age of less than 1 year old at 9 weeks and 6 months after operation was significantly higher than that of children with 1 to 2 years age in both roups (P < 0.05).Conclusion Application of adjustable shunt drainage in VPS can effectively improve the therapeutic effect, the prognosis and cognitive function of children.
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表 1 2组患儿一般资料比较
一般资料 VPS组(n=45) ETV组(n=44) 年龄 5个月~2岁 6个月~2岁 年龄分布/例 1岁以下 30 28 1~2岁 15 16 性别/例 男 26 24 女 19 20 体质量/kg 5.29~13.80 5.36~14.03 脑积水类型/例 交通性脑积水 36 33 阻塞性脑积水 9 11 
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表 2 2组术后疗效及相关指标比较(x±s)[n(%)]
组别 n 疗效 术中出血量/mL 手术成功 术后感染 住院时间/d 无效 显效 VPS组 45 3(6.67)* 42(93.33)* 82.78±18.37* 44(97.78)* 11(24.44)* 13.49±1.21 ETV组 44 6(13.64) 38(86.36) 65.17±10.64 39(88.64) 3(6.82) 13.63±1.88 与ETV组比较, *P < 0.05。
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表 3 2组患儿术前、术后脑室额角宽度和第三脑室宽度变化情况比较(x±s)
mm 组别 时点 脑室额角宽度 第三脑室宽度 VPS组(n=45) 术前 65.31±8.96 28.68±5.24 术后2周 60.71±10.74 25.70±5.17 术后9周 59.38±9.76 24.02±4.18 术后6个月 58.35±9.26* 22.76±4.13* ETV组(n=44) 术前 66.12±8.26 29.24±6.04 术后2周 61.33±8.80 26.82±5.11 术后9周 61.02±8.74 25.27±4.87 术后6个月 60.08±8.24* 24.16±4.13* 与术前比较, *P < 0.05。
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表 4 2组患儿术后认知功能情况比较(x±s)
分 Gesell智力测试 ETV组(n=44) VPS组(n=45) 精细运动行为 44.18±6.13* 57.20±7.36 大运动行为 42.18±5.87* 49.18±6.35 语言能力 39.76±4.31* 46.72±6.02 适应能力 34.39±5.28* 42.71±5.14 个人-社会行为 40.74±4.92* 46.57±5.86 DQ值 80.39±7.28* 83.51±7.02 与VPS组比较, *P < 0.05。
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表 5 2组患儿术前、术后DQ变化情况比较(x±s)
分 组别 时点 1~2岁 1岁以下 ETV组(n=44) 术后2周 52.12±12.03 56.84±8.66 术后9周 64.53±15.58 75.42±5.17* 术后6个月 75.32±18.01 85.17±5.91* VPS组(n=45) 术后2周 53.22±9.37 55.06±6.21 术后9周 67.02±10.64 75.56±8.58* 术后6个月 78.32±12.90 87.42±3.18* 与1~2岁比较, *P < 0.05。
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[1] 郑倩, 金奕. 小儿脑室腹腔分流术围术期低体温的相关因素及其护理进展[J]. 解放军护理杂志, 2015, 32(6): 49-51. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201506014.htm [2] 张海泉, 王志勇, 敖祥生, 等. 脑室-腹腔分流术治疗小儿脑积水[J]. 中国临床神经外科杂志, 2017, 22(1): 34-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLC201701013.htm [3] 汪迪飞. 儿童脑积水外科治疗进展[J]. 重庆医学, 2016, 45(22): 3145-3145. doi: 10.3969/j.issn.1671-8348.2016.22.046 [4] 代礼, 周光萱, 缪蕾, 等. 1996至2004年中国围产儿先天性脑积水的发生状况分析[J]. 中华预防医学杂志, 2006, 40(3): 180-183. doi: 10.3760/j:issn:0253-9624.2006.03.009 [5] 阳燕青, 刘寰, 肖格磊. 脑室镜下脑室-腹腔分流术治疗5个月至6岁小儿脑积水106例分析[J]. 中国内镜杂志, 2015, 21(6): 668-670. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201506028.htm [6] 孙关, 郭俊, 聂德康, 等. 神经内镜下第三脑室底造瘘术治疗儿童梗阻性脑积水疗效分析[J]. 中华神经医学杂志, 2016, 15(9): 941-944. doi: 10.3760/cma.j.issn.1671-8925.2016.09.014 [7] 黄玉宝, 陈子祥, 张俊全, 等. 脑室-腹腔分流术治疗结核性脑膜炎性脑积水10例[J]. 中国微侵袭神经外科杂志, 2017, 22(3): 123-125. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWQX201703008.htm [8] 霍龙伟, 陈晨, 郑虎林. 小儿先天性脑积水手术治疗分析[J]. 基层医学论坛, 2015, 19(28): 3923-3924. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT201528024.htm [9] 安宗剑, 鲍南, 杨波, 等. 神经内镜下第三脑室底造瘘术治疗儿童脑积水[J]. 中华神经外科杂志, 2017, 33(1): 24-27. doi: 10.3760/cma.j.issn.1001-2346.2017.01.007 [10] Santamarta D, Martin-Vallejo J, Díaz-Alvarez A, et al. Changes in ventricular size after endoscopic third ventriculostomy[J]. Acta Neurochirurgica, 2008, 150(2): 119-127. doi: 10.1007/s00701-007-1477-6
[11] 翟文华. 脑室腹腔分流术后分流管梗阻的护理干预[C]. 中华护理学会第8届全国造口、伤口、失禁护理学术交流会议、全国外科护理学术交流会议、全国神经内、外科护理学术交流会议论文汇编, 2011: 742-744. [12] 谢方民, 陈晓雷, 张春普, 等. 第三脑室底形态在预测内镜下三脑室底造瘘术是否成功的意义[J]. 中华脑科疾病与康复杂志: 电子版, 2013, 3(3): 60-61. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHNB201303018.htm [13] 吉文玉, 汪永新, 图柯拜, 等. 儿童先天性脑积水的手术治疗效果分析[J]. 实用心脑肺血管病杂志, 2018, 26(5): 81-84. doi: 10.3969/j.issn.1008-5971.2018.05.020 [14] 刘云义, 赵敬璞, 倪莹莹, 等. 先天性脑积水致皮质扁平样变对患者运动及认知功能的影响[J]. 中华物理医学与康复杂志, 2017, 39(10): 753-755. doi: 10.3760/cma.j.issn.0254-1424.2017.10.008 [15] Gianaris T J, Nazar R, Middlebrook E, et al. Failure of ETV in patients with the highest ETV success scores[J]. Journal of Neurosurgery Pediatrics, 2017, 20(3): 225-231. doi: 10.3171/2016.7.PEDS1655
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