脑室腹膜分流术治疗小儿结核性脑膜炎脑积水

Ventriculoperitoneal shunting in childhood tuberculous meningitis hydrocephalus

目的总结小儿结核性脑膜炎后脑积水(TBMH)行脑室腹膜分流术(VPS)的效果,分析其影响因素,探讨VPS的适应证和时机。方法总结我院经VPS治疗小儿TBMH病例56例,部分病例VPS手术前行脑室外引流(EVD)。结果手术后GOS分级,效果较好(恢复良好和中度致残)33例,占58.9%;效果较差(重度致残、植物生存和死亡)23例,占41.1%。手术后GOS与手术前GCS分级、TBM分级、手术前抗结核治疗时间等有关,而与患儿的年龄、手术前是否有癫痫发作、脑积水的类型和程度、手术前CSF细胞计数和蛋白含量等无关。发生非感染性堵管4例,分流管感染2例,腹部伤口感染1例,腹部CSF囊肿1例。结论VPS治疗TBMH可以取得较好的效果,手术前GCS和TBM分级是影响TBMH患儿行VPS治疗预后最重要的因素。

Objective To evaluate the prognostic factors which determine the final outcome of ventriculoperitoneal shunting （VPS） in childhood tuberculous meningitis hydrocephalus （TBMH）. Methods Clinical data from 56 children with tuberculous meningitis （TBM） and hydrocephalus were reviewed. VPS was performed if the hydrocephalus was norrcommunicating or following failed medical therapy if the hydrocephalus was communicating. Nine factors were evaluated in each ease, including age at admission,GCS and TBM grade before surgery, type and degree of hydrocephalus, CSF protein level and cell content, period of antituberculous therapy and preoperative seizure. These patients were followed for one year and their outcomes were assessed using the Glasgow Outcome Scale （COS）. Resalts In these 56 children,21 patients got good outcome and 12 with moderate disability, 15 with severe disability,4 with vegetative state and 4 died. Good outcome and moderate disability was seen in 33 patients （58. 9%） and poor outcome （severe disability, vegetative or dead） in 23 patients （41.1%）. The GCS, the TBM grade and the period of antituberculous therapy were found to be statistically significant in determining final outcome （P value of 0. 001,0. 011 and 0. 026 respectively）. Complications were found in 8 patients： 4 patients suffered from drainage obstruction,2 patients with drainage infection, 1 patient with wound infection and 1 patient with intraabdominal CSF pseudocyst. Conclusions VPS is an effective treatment of child TBMH. The GCS and the TBM grade are the useful indexes in determining final outcome in children with TBMH.