儿童后颅窝肿瘤术前梗阻性脑积水的治疗

Management of obstructive hydrocephalus before posterior fossa tumor resection in children

目的探讨儿童后颅窝肿瘤术前梗阻性脑积水的治疗。方法回顾性分析本院2008年1月±2012年6月收治的162例儿童后颅窝肿瘤伴梗阻洼脑积水的治疗，患儿分2组：A组（90例）肿瘤切除前行Ommaya储液囊外引流术；B组（72例）：肿瘤切除前行脑室腹腔分流术。比较治疗结果及并发症。结果术后并发症67例。其中感染27例（16．7％），分流管阻塞19例，硬膜下积液或血肿16例（9．87％），脑室裂隙综合征5例，瘤体上疝4例（2．47％）。组间对比分析表明，硬膜下积液或血肿的发生率差异有统计学意义（P=0．039），分流管阻塞发生率差异有统计学意义（P=0．047），颅内感染、瘤体上疝发生率差异无统计学意义（P=0．478，P=0．462）。结论Ommaya储液囊外流术是解决儿童后颅窝肿瘤术前脑积水的常规手段，手术简便、创伤小、并发症少，值得临床广泛应用。

Objective To explore the management of obstructive hydrocephalus caused by posterior fossa tumors before tumor resection in children. Methods The clinical data were reviewed of 162 pediatric patients of posterior fossa tumors with obstructive hydrocephalus undergoing surgical tumor removal between January 2008 and June 2012. Ninety children received preoperative Ommaya external drainage （group A） and 72 underwent preoperative ventriculo-peritoneal shunting （V-Ps） （group B）. The therapeutic effects were evaluated and compared between the two groups. Results Postoperative complications found in a total of 67 cases including infection （27）, shunt blockage （19）, subdural hematoma or effusion （16）, ventricle fissure syndrome （5）, and tumor hernia （4）. Significant differences were found in the incidences of shunt blockage （P--0.047） and subdural hematoma or effusion （P=0.039） but not in the incidences of intracranial infection （P=0.478） or tumor hernia （P=0.462） between the two groups. Conclusion Ommaya reservoir can produce good results through simple surgical procedures for treatment of acute hydrocephalus in children with posterior fossa tumors and is associated less trauma and complications.