儿童脑积水第三脑室底造瘘术后脑认知功能的研究

Research of children＇s neurocognitive function after third ventriculostomy for hydrocephalus

目的探讨儿童脑积水第三脑室底造瘘术后脑认知功能变化情况。方法回顾分析儿童脑积水43例，其中行第三脑室底造瘘术20例（手术组），对手术前后的CT／MRI、脑电图、SPECT、发育商DQ进行对比，评价术后患儿脑认知功能康复的情况。未行手术23例（未手术组），出院后正常育儿，于诊断后2周、2个月、6个月行发育商（DQ）测定。结果手术组术后2周与术前及未手术组比较发育商差异无统计学意义（P〉0．05），手术组术后2个月、6个月与未手术组比较发育商差异有统计学意义（P〈0．05），手术组术后2个月、6个月与术前相比发育商有统计学意义（P〈0．01）。手术组术后发育商（DQ）值呈上升趋势改变（P〈0．01），术后脑室大小较术前变化不明显，脑电图异常率、SPECT脑血流灌注显像与术前相比差异均有统计学意义（P〈0．01）。结论儿童脑积水行第三脑室底造瘘术可使脑认知功能改善，术后脑室大小的变化不明显。

Objective To research the children＇s neurocognitive function changes after third ventriculostomy of hydrocephalus. Methods We retrospectively analyzed the medical files of 43 cases of children with hydrocephalus, including the endoscopic third ventriculostomy of 20 cases（ Operation Group）. The data regarding CT/MRI, EEG, SPECT, developmental quotient （DQ）before and after surgery were studied. We eveluated the children neurocognitive function recovery time and degree effect in postoperative stage. Surgery was not done in 23 cases （without operation group）, in which developmental quotient （DQ） is measured after two weeks ,2 month and 6 months of the diagnosis. Results The two groups after 2 month and 6 months of operation were compared developmental quotient difference were significant （ P 〈 0. 05 ）. In operation group： 2 month and 6 months after operation compared with the preoperative developmental quotient difference were significant （ P 〈 0. 01 ）, operation group developmental quotient （ DQ ） value showed ascendant trend change （ P 〈0. 01 ）. Comparing with the preoperative, postoperative ventricle size did not change significantly. The EEG abnormal rate, ECT cerebral blood perfusion imaging comparing with preoperative difference were significant （ P 〈 0. 01 ）, with a statistical significance. Conclusions Children after ETV can make neurocognitive function recovery, postoperative ventricular size change and improve is not obvious.