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-腹腔引流术中的效能评价

Efficiency evaluation of adjustable shunt drainage in ventriculoperitoneal drainage within 6 months for children with congenital hydrocephalus

  • 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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