儿童后颅窝肿瘤合并脑积水的治疗及预后影响因素分析

Treatment and prognosis of posterior fossa tumor combined with hydrocephalus in children： an analysis of influencing factors

目的 探讨儿童后颅窝肿瘤合并脑积水患者行肿瘤切除术前对于脑积水的治疗是否影响术后脑积水的发生率,并分析术后脑积水发生的相关危险因素.方法 中山大学附属第一医院神经外科自2003年1月至2009年12月行肿瘤切除术治疗后颅窝肿瘤合并脑积水儿童患者63例,其中对术前脑积水行保守治疗43例,手术治疗20例.回顾性分析患者的临床资料并比较术前脑积水保守治疗组和手术治疗组患者术后脑积水的发生率,Logistic回归分析患者的性别、发病年龄、术前Evans指数、肿瘤病理类型、肿瘤切除程度、肿瘤生长部位等因素是否与术后脑积水的发生有关.结果 术后出现脑积水患者22例,其中术前脑积水保守治疗组14例（14/43,32.6%）,术前脑积水手术治疗组8例（8/20,40.0%）,2组比较脑积水发生率差异无统计学意义（P=0.564）;Logistic 回归分析发现患者术前Evans指数、肿瘤生长部位、肿瘤切除程度与肿瘤切除术后脑积水的发生有关（P=0.029,p=0.036,P=0.038）.结论 肿瘤切除术前脑积水的治疗并不能改变术后脑积水的发生率：术前Evans指数、肿瘤生长部位、肿瘤切除程度是肿瘤切除术后脑积水发生的危险因素.

Objective To explore whether preoperative treatment of hydrocephalus could change the occurrence of postoperative hydrocephalus after tumor resection in children with posterior fossa tumor, and analyze the risk factors of postoperative hydrocephalus. Methods Sixty-three children with posterior fossa tumors accompanied with hydrocephalus, admitted to our hospital from January 2003 to December 2009, were chosen; conservative treatment of preoperative hydrocephalus was performed in 43 patients and surgery was performed in the other 20 patients. The clinical data of these patients were retrospectively analyzed and the occurrence of postoperative hydrocephalus in patients performed conservative treatment and tumor resection was compared. Gender, age, Evans index, location of the tumor, extent of the tumor resection, pathology of the tumor were analyzed as risk factors using logistic regression. Results Occurrence of hydrocephalus after tumor resection showed no statistical differences between patients accepted conservative treatment （14/43, 32.6%） and patients received surgical treatment （[8/20, 40.0%], P=0.564）. Evans index, location of the tumor and extent of resection were related to hydrocephalus relapse after tumor resection（P=0.029, P=0.036, P=0.038）. Conclusion Preoperative treatment of hydrocephalus could not change the occurrence of hydrocephalus after tumor resection. Evans index, location of the tumor and extent of tumor resection are all risk factors of postoperative hydrocephalus.