小儿颅内蛛网膜囊肿手术治疗探讨

Surgical intervention strategies for pediatric intracranial arachnoid cysts

目的 探讨小儿颅内蛛网膜囊肿（IACs）的手术治疗方法. 方法对福建医科大学附属第一医院神经外科自2003年1月至2013年10月收治的76例IACs患儿进行外科干预,其中行囊肿-腹腔分流术40例、造瘘术36例（含显微镜下囊肿造瘘术31例,内镜囊肿造瘘术5例）,术后随访3个月至6年[平均（32.41 ±8.56）个月].根据术后囊肿体积的变化及患儿症状缓解情况判断疗效,并随访手术近期并发症（术后2个月内）和远期并发症（术后2个月后）情况. 结果 行囊肿-腹腔分流术患者有效率为80％（32/40）;术后近期并发症发生率为17.50％（7/40）：脑脊液瘘、颅内感染各3例,切口感染1例;远期并发症发生率为22.50％（9/40）：分流管依赖3例,颅内感染、分流管堵塞各2例,分流管脱出、皮肤通道感染各一例.行囊肿造瘘术患者有效率为91.67％（33/36）;术后近期并发症发生率为8.33％（3/36）：颅内感染1例,硬膜下血肿2例;远期并发症发生率为0.2种不同手术方法的有效率及手术近期并发症发生率比较差异无统计学意义（x2=1.126,P=0.289;x2=0.707,P=0.401）,但分流术的手术远期并发症发生率明显高于造瘘术,差异有统计学意义（x2=7.159,p=0.008）. 结论 IACs患儿可优先选择造瘘术,尽量避免行分流术.

Objective To investigate the operation strategy of pediatric intracranial arachnoid cysts （IACs）.Methods Surgical intervention was performed in 76 patients with pediatric IACs,admitted to our hospital from January 2003 to October 2013; cyst-peritoneal shunt was chosen in 40 patients and fistulation in 36 （including microscopic fistulation in 31 and endoscopic fistulation in 5）.According to the changes of cyst volume and the relief of symptoms,the efficacy was evaluated,and the complications after operation,including the recent complications （within 2 months of operation） and long-term complications （longer than 2 months of surgery）,were observed.Results The efficiency of cysts-peritoneal shunt was 80% （32/40）; the rate of recent complication for patients performed cysts-peritoneal shunt was approximately 17.5% （7/40）,including 3 of CSF leakage,3 of intracranial infection and 1 of wound infection; the rate of long-term complications was approximately 22.5% （9/40）,including 3 of shunt-dependency,2 of intracranial infection,2 of obstruction of the catheter,1 of off the catheter and 1 of skin channel infections.Meanwhile,the efficiency of fistulation was approximately 91.67% （33/36）; the rate of recent complication was approximately 8.33% （3/36）,including 1 of intracranial infection,2 of subdural hematoma; the rate of long-term complications was 0.Significant difference was noted in the surgical efficiency （x2=1.126,P=0.289） and the rate of recent complication （x2=0.707,P=0.401） between cyst-peritoneal shunt and fistulation; however,the rate of long-term complications in patients after cyst-peritoneal shunt insertion was significantly higher than that in patients after fistulation （x2=7.159,P=0.008）.Conclusion Fistulation might be the preferred method for pediatric IACs,and shunt should be avoided.