摘要
目的探讨一期颅骨成形术联合脑室外引流术治疗合并脑积水的婴幼儿枕后型脑膜脑膨出的效果。方法回顾性分析分2015年10月至2020年10月收治的22例(观察组)合并脑积水的婴幼儿枕后型脑膜脑膨出的临床资料,采用一期颅骨成形术联合脑室外引流术治疗。另选取2010~2015年收治的23例合并脑积水的婴幼儿枕后型脑膜脑膨出为对照,仅行开颅成形术,未行脑积水脑室外引流术。结果两组术中及术后拔管时颅内压均明显降低(P<0.05),而且观察组明显低于对照组(P<0.05)。观察组术后6个月癫痫发生率[13.64%(3/22)]与继发脑积水发生率[4.55%(1/22)]均明显低于对照组[分别为34.78%(8/23)、39.13%(9/23);P<0.05]。观察组术后6个月Gesell儿童智力发育诊断量表评分明显高于对照组(P<0.05)。观察组重度神经发育障碍(DQ<40)发生率[9.10%(2/22)]明显低于对照组[39.13%(9/23);P<0.05]。结论对于婴幼儿合并脑积水的枕后型脑膜脑膨出,与单纯开颅成形术相比,采用一期开颅成形术联合脑室外引流术可明显降低颅内压,减少术后癫痫、继发脑积水,改善患儿认知功能,提高患儿智力水平。
Objective To explore the clinical efficacy of one-stage cranioplasty combined with external ventricular drainage(EVD)for the infants with occipital meningoencephalocele associated with hydrocephalus.Methods A retrospective analysis was performed on the clinical data of 22 infants with occipital meningoencephalocele associated with hydrocephalus(observation group)who underwent one-stage cranioplasty combined with EVD from October 2015 to October 2020 and of 23 infants with occipital meningoencephalocele associated with hydrocephalus who underwent simple cranioplasty from 2010 to 2015(control group).Results The intracranial pressures during the operation and after the extubation were significantly reduced in the two groups compared with before the operation(P<0.05).The intracranial pressures during the operation and after the extubation were significantly reduced in the observation group than those in control group(P<0.05).The postoperative incidences of epilepsy[13.64%(3/22)]and secondary hydrocephalus[4.55%(1/22)]in the observation group were significantly lower than those[34.78%(8/23)and 39.13%(9/23),respectively]in the control group(P<0.05).The Gesell Development Diagnosis Scale score of the observation group were significantly higher than that of the control group(P<0.05).The incidence of severe neurodevelopmental disorders(DQ<40)in the observation group[9.10%(2/22)]was significantly lower than that[39.13%(9/23)]in the control group(P<0.05).Conclusions For infants with occipital meningoencephalocele associated with hydrocephalus,compred with simple cranioplasty,one-stage cranioplasty combined with EVD can significantly reduce intracranial pressure,reduce postoperative epilepsy and secondary hydrocephalus,improve patients'cognitive function and intelligence.
作者
冯强
齐林
董留建
王朝林
冯书彬
FENG Qiang;QI Lin;DONG Liu-jian;WANG Chao-lin;FENG Shu-bin(Department of Neurosurgery,Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital,Zhengzhou 450000,China)
出处
《中国临床神经外科杂志》
2021年第9期673-675,共3页
Chinese Journal of Clinical Neurosurgery
关键词
脑膜脑膨出
婴幼儿
脑积水
颅骨成形术
脑室外引流术
Occipital meningoencephalocele
Hydrocephalus
Infants
Cranioplasty
External ventricular drainage
