CAJ | 학술논문

目的探讨小儿颅内蛛网膜囊肿(IACs)的手术治疗方法. 方法对福建医科大学附属第一医院神经外科自2003年1月至2013年10月收治的76例IACs患儿进行外科干预,其中行囊肿-腹腔分流术40例、造瘘术36例(含显微镜下囊肿造瘘术31例,内镜囊肿造瘘术5例),术后随访3个月至6年[平均(32.41 ±8.56)个月].根据术后囊肿体积的变化及患儿症状缓解情况判断疗效,并随访手术近期并发症(术后2个月内)和远期并发症(术后2个月后)情况. 结果行囊肿-腹腔分流术患者有效率为80％(32/40);术后近期并发症发生率为17.50％(7/40):脑脊液瘘、颅内感染各3例,切口感染1例;远期并发症发生率为22.50％(9/40):分流管依赖3例,颅内感染、分流管堵塞各2例,分流管脱出、皮肤通道感染各一例.行囊肿造瘘术患者有效率为91.67％(33/36);术后近期并发症发生率为8.33％(3/36):颅内感染1例,硬膜下血肿2例;远期并发症发生率为0.2种不同手术方法的有效率及手术近期并发症发生率比较差异无统计学意义(x2=1.126,P=0.289;x2=0.707,P=0.401),但分流术的手术远期并发症发生率明显高于造瘘术,差异有统计学意义(x2=7.159,p=0.008). 结论 IACs患儿可优先选择造瘘术,尽量避免行分流术.
목적 탐토소인로내주망막낭종(IACs)적수술치료방법. 방법대복건의과대학부속제일의원신경외과자2003년1월지2013년10월수치적76례IACs환인진행외과간예,기중행낭종-복강분류술40례、조루술36례(함현미경하낭종조루술31례,내경낭종조루술5례),술후수방3개월지6년[평균(32.41 ±8.56)개월].근거술후낭종체적적변화급환인증상완해정황판단료효,병수방수술근기병발증(술후2개월내)화원기병발증(술후2개월후)정황. 결과 행낭종-복강분류술환자유효솔위80％(32/40);술후근기병발증발생솔위17.50％(7/40):뇌척액루、로내감염각3례,절구감염1례;원기병발증발생솔위22.50％(9/40):분류관의뢰3례,로내감염、분류관도새각2례,분류관탈출、피부통도감염각일례.행낭종조루술환자유효솔위91.67％(33/36);술후근기병발증발생솔위8.33％(3/36):로내감염1례,경막하혈종2례;원기병발증발생솔위0.2충불동수술방법적유효솔급수술근기병발증발생솔비교차이무통계학의의(x2=1.126,P=0.289;x2=0.707,P=0.401),단분류술적수술원기병발증발생솔명현고우조루술,차이유통계학의의(x2=7.159,p=0.008). 결론 IACs환인가우선선택조루술,진량피면행분류술.
Objective To investigate the operation strategy of pediatric intracranial arachnoid cysts (IACs).Methods Surgical intervention was performed in 76 patients with pediatric IACs,admitted to our hospital from January 2003 to October 2013; cyst-peritoneal shunt was chosen in 40 patients and fistulation in 36 (including microscopic fistulation in 31 and endoscopic fistulation in 5).According to the changes of cyst volume and the relief of symptoms,the efficacy was evaluated,and the complications after operation,including the recent complications (within 2 months of operation) and long-term complications (longer than 2 months of surgery),were observed.Results The efficiency of cysts-peritoneal shunt was 80％ (32/40); the rate of recent complication for patients performed cysts-peritoneal shunt was approximately 17.5％ (7/40),including 3 of CSF leakage,3 of intracranial infection and 1 of wound infection; the rate of long-term complications was approximately 22.5％ (9/40),including 3 of shunt-dependency,2 of intracranial infection,2 of obstruction of the catheter,1 of off the catheter and 1 of skin channel infections.Meanwhile,the efficiency of fistulation was approximately 91.67％ (33/36); the rate of recent complication was approximately 8.33％ (3/36),including 1 of intracranial infection,2 of subdural hematoma; the rate of long-term complications was 0.Significant difference was noted in the surgical efficiency (x2=1.126,P=0.289) and the rate of recent complication (x2=0.707,P=0.401) between cyst-peritoneal shunt and fistulation; however,the rate of long-term complications in patients after cyst-peritoneal shunt insertion was significantly higher than that in patients after fistulation (x2=7.159,P=0.008).Conclusion Fistulation might be the preferred method for pediatric IACs,and shunt should be avoided.