CAJ | 학술논문

目的探讨第四脑室肿瘤相关性脑积水的治疗.方法总结天津市环湖医院自2008年5月至2010年5月间收治的31例第四脑室周围肿瘤患儿脑积水的处理结果.患者分为3组:A组(5例):肿瘤切除术前行脑室-腹腔分流术;B组(15例):肿瘤切除术后处理组,又分为B1组(7例),即术后仍有脑积水实施脑室分流术;B2组(8例):第三脑室底造瘘术;C组(11例),肿瘤切除术后脑积水自行缓解.患儿长期随访中出现的脑积水症状以及各方法的并发症出现情况对比;影像学以MRI脑室相关径线的改变为评价指标.结果 A组术前2 d行脑室-腹腔分流者,术后未再出现脑积水症状,1例有裂隙脑室;B1组7例脑室-腹腔分流术,1例裂隙脑室,1例分流管梗阻更换分流管;B2组8例行第三脑室底造瘘术,2例头皮缝合口漏,1例硬膜下积液.组间对比分析表明,A组和B组间,B1和B2组问并发症的发生率差异无统计学意义(P>0.05);MRI脑室各相关径线值改变差异无统计学意义(P>0.05).结论脑室-腹腔分流或第三脑室底造瘘方法均能解决第四脑室肿瘤相关性脑积水.
목적 탐토제사뇌실종류상관성뇌적수적치료.방법 총결천진시배호의원자2008년5월지2010년5월간수치적31례제사뇌실주위종류환인뇌적수적처리결과.환자분위3조:A조(5례):종류절제술전행뇌실-복강분류술;B조(15례):종류절제술후처리조,우분위B1조(7례),즉술후잉유뇌적수실시뇌실분류술;B2조(8례):제삼뇌실저조루술;C조(11례),종류절제술후뇌적수자행완해.환인장기수방중출현적뇌적수증상이급각방법적병발증출현정황대비;영상학이MRI뇌실상관경선적개변위평개지표.결과 A조술전2 d행뇌실-복강분류자,술후미재출현뇌적수증상,1례유렬극뇌실;B1조7례뇌실-복강분류술,1례렬극뇌실,1례분류관경조경환분류관;B2조8례행제삼뇌실저조루술,2례두피봉합구루,1례경막하적액.조간대비분석표명,A조화B조간,B1화B2조문병발증적발생솔차이무통계학의의(P>0.05);MRI뇌실각상관경선치개변차이무통계학의의(P>0.05).결론 뇌실-복강분류혹제삼뇌실저조루방법균능해결제사뇌실종류상관성뇌적수.
Objective To investigate the management of hydrocephalus caused by tumors of the 4th ventricule. Method Thirty - one children with tumors of the 4th ventricule treated in Huanhu hospital in Tianjin,among which 13 patients had medulloblastoma, 13 ependymoma,3 astrocytoma and 2 choroid plexus papilloma. The patients were divided into three groups. Group A (5 cases): all the patients preoperatively accepted ventriculo - peritoneal shunting(V -Ps). Group B(15 cases): postoperative management group, which was divided into two subgroups,group B1 and group B2. V -Ps were performed in group B1(7 cases) for hydrocephalus after resection of tumor and endoscopic third ventriculostomy ( ETV) in group B2 (8 cases). The patients in group C ( 11 cases) did not develope hydrocephalus after tumor resection. Results There was no postoperative hydrocephalic sign in 5 patients treated by V - Ps 2 days before tumor resection. 15 out of 31 patients(48% ) developed hydrocephalus after resection of tumor. 7( group B1) of 15 patients were treated with V - Ps,of them one had slit ventricule and one recepted shunt tube reversion. 8 (group B2)of 15 patients underwent ETV,of them one had subdural hydroma and 2 had leakage of incisioa 11 (group C) out of 31(35% ) had no hydrocephalus. Radiological assessement was performed with 4 ventricule index( Ⅵ),including the maximal width of frontal horns,occipital horns,biparietal and 3th ventricule. There was no significant diference ( P > 0. 05 ) among the three groups in ventricule indexes and postoperative complications. Conclusions The 4th ventricule tumor - related hydrocephalus could be resolved by V - Ps or ETV. It is more rational to deal with the hydrocephalus just after the resection of tumor.