超声引导下脑室内神经干细胞移植术在小儿脑瘫中的应用

Transplantation of neural stem cells through the lateral ventricle guided by ultrasonography in treating the cerebral palsy of children

目的小结超声引导下经皮侧脑室穿刺术的经验,并观察脑瘫患儿脑室内神经干细胞移植的近期疗效。方法 45例不同病因的脑瘫患儿接受了超声引导下经皮穿刺脑室内神经干细胞移植术。神经干细胞来自自然流产的孕12周人胚胎前脑组织;超声仪器为常规彩色多普勒诊断仪,普通扇扫探头,频率2.0-4.0 MHz,带有穿刺架和引导软件。结果 45例患儿共接受了56次超声引导下侧脑室穿刺,1次穿刺成功率为100%,脑室内注入神经干细胞（NSCs）0.3-1.2（0.8±0.5）ml,细胞计数3.8×106-7.2×107（1.2×107±6.8×106）个。3例患儿有轻度的脑室血管损伤;有14例患儿术后出现发热,经对症处理恢复正常。移植术后,21例（约46.7%）患儿的近期临床表现有不同程度的好转,无一例患儿出现原有病情加重。结论超声引导下脑室内神经干细胞移植术是安全的,穿刺成功率高,有助于改进脑瘫患儿的临床治疗。

Objective To summarize briefly the course of puncture of the lateral ventricle percutaneously guided by real-time ultrasonography and to observe the short-term effectiveness of transplantation of human fetal neural stem cells into the cerebral ventricle in treatment of cerebral palsy（CP） of children.Methods Forty-five cases of CP of children with different causes underwent transplantation of neural stem cells through the lateral ventricle guided by ultrasonography,in which NSCs were obtained from the forebrain of 12-week old fetuses because of natural abortion.A phased array scanning probe of ultrasound with color Doppler and puncture guidance software was used during the operation.Results Fifty-six taps were carried out and 0.3-1.2（0.8±0.5）ml suspensions containing 3.8×106-7.2×107（1.2×107±6.8×106）NSCs were injected into the lateral ventricles in the 45 cases.The success rate of once puncture was 100%,during which mild injury lateral ventricle blood vessel of the children occurred in only 3 cases.Although there were 14 cases had a fever,short-term clinical manifestations were improved in varying degrees in 21 cases（about 46.7%） after the transplantation.No patient＇s condition worsened because of the operation in this group.Conclusion Transplantation of NSCs into the lateral ventricle guided by ultrasonography was safe and accurate,which would be a helpful and effect way in the clinical therapy for CP of children.