储液囊埋植引流治疗极低体质量早产儿脑室内出血致脑积水的疗效分析

Ventricular reservoirs drainage for very low birth weight infants with posthemorrhagic hydrocephalus

目的评估储液囊埋植引流治疗极低体质量早产儿脑室内出血致脑积水的疗效分析。方法回顾性分析2005年1月至2011年6月期间，温州医学院第二附属医院收治的12例出生时体质量〈1500g的极低体质量早产儿脑室内出血合并脑积水，进行储液囊埋植引流治疗。储液囊埋植后根据临床表现和影像学检查结果，决定脑脊液引流次数，间歇引流时间和引流量，并观察术后的并发症。若储液囊引流无效者，改行脑室一腹腔分流术。结果12例脑室出血Ⅲ级8例，Ⅳ级4例，孕龄26～32周，出生时平均体质量为（1023±223）g。埋植Ommaya储液囊时日龄为（17．7±3．1）d，平均体质量为（1126±236）g。术后1例患儿死于肺部相关并发症，存活的11例患儿中，7例未发现脑室进行性扩大，3例取出储液囊。4例出现脑积水，行脑室一腹腔分流术，并同时取出储液囊。储液囊埋植引流的相关主要并发症（皮肤裂开、脑脊液漏、脑脊液感染、脑室出血）发生率为6／12例（50％），3例出现皮肤切口裂开合并发生脑脊液感染，2例单独出现脑脊液感染，1例术后出现脑室出血。结论储液囊脑室埋植引流治疗极低体质量早产儿脑室内出血致脑积水具有操作简单、疗效满意、预防或减轻部分患儿脑积水的进一步发展、避免行永久性分流术等优点，但其并发症的发生率相对较高，采用改良的手术方法可降低并发症的发生。

Objective To evaluate safety, efficacy and complications of the implantation of Ommaya reservoir in very low birth weight infants with posthemorrhagie hydrocephalus （PHH）. Methods 12 consecutively very low birth weight infants presenting with progressive ventricular dilatation caused by intra - ventricular haemorrhage （ IVH ） grades Ill to IV were operated for implantation of an intra - ventricular catheter connected to a sub - cutaneous Ommaya reservoir from January 2005 to June 2011. Cerebrospinal fluid draining frequency, intermittent draining time and draining volume were conducted according to clinical manifestations and echographie follow -up, and the complications were observed postoperatively. The patients who presented a progression of the ventrieular dilatation were finally operated for VP shunt implant according to the CT/MRI findings. Results 12 very low birth weight infants with PHH were treated with the placement of an Ommaya reservoir. 8 had grade III, and 4 had grade IV IVH. The mean gestational age was 29.1 weeks （26 -32） and birth weight was 1023g （770 - 1450） at birth. The mean age when reservoir implanted was 17. 7 （ 13 - 23 ） days and body weight was 1126g （ 890 - 1560）. One patient died of pulmonary complications during the study period. Out of the 11 survivors, 7 did not develop progressive ventrieular dilatation, and 3/7 reservoirs were removed; 4 developed progressive hydrocephalus were implanted with a ventriculoperitoneal shunts, and the reservoirs were removed. Postsurgical major complications （including skin dehiscence, CSF leak, CSF infection, ventricular hemorrhage） occurred in 50% of all patients. Among these, skin dehiscence and CSF leak occurred in 3, CSF infection in 2, significant secondary hemorrhage in 1. Conclusions The placement of Ommaya reservoir and serial tapping in very low birth weight infants with PHH is a safe, feasible, and effective method with advantages of preventing the development of hydrocephalus and avoiding the placement of a permanent preoperative shunt in some patients. Despite a relatively high complication rate, modified techniques may reduce these complications.