不同年龄段婴幼儿先天性梗阻性脑积水三脑室底造瘘术后神经发育状态

Neurodevelopmental outcomes in pediatric patients of different ages undergoing endoscopic third ventriculostomy for the treatment of congenital obstructive hydrocephalus

目的探讨婴幼儿先天性梗阻性脑积水经神经内镜三脑室底造瘘术(ETV)治疗疗效。方法 2011年7月至2014年1月,将33例经ETV治疗的先天性梗阻性脑积水患儿根据手术年龄段分为ETV≤6月组(n=17)与ETV>6月组(n=16),随访术后6个月并进行神经发育评测(采用Gesell儿童智力发育诊断量表,包括大运动行为、精细运动行为,适应能力、语言功能及个人一社会行为)。比较两组患儿手术疗效与术后神经发育状态。结果 ETV≤6月组与ETV>6月组术后神经发育预后具有统计学差异(P﹤0.05),ETV≤6月组患儿在大运动行为,精细运动行为,适应能力,语言功能及个人-社会行为方面均不如于ETV>6组患儿(23.00±3.62vs.48.81±6.81;25.94±3.07 vs.55.56±8.40;15.00±3.06 vs.40.94±6.69;20.00±3.06 vs.45.81±6.81;21.12±3.22 vs.45.88±7.22);ETV≤6组患儿中,重度神经发育障碍17例(100%)(DQ值﹤40),而ETV>6月组患儿中重度神经发育障碍1例(6.25%)。结论出生6个月以内行神经内镜下三脑室底造瘘术(ETV)治疗婴幼儿先天性梗阻性脑积水手术成功率低,术后神经发育预后欠佳。

ObjectiveTo investigate the effect of endoscopic third ventriculostomy（ETV）on congenital obstructive hydrocephalus in pediatric patients.MethodsWe prospectively evaluated the postoperative neurodevelopmental outcomes in 33 children with congenital obstructive hydrocephalus who underwent endoscopic third ventriculostomy at different ages from June 2011 to Jan 2014. According to their ages at the time of surgery, we categorized them into two groups：ETV≤6 months of live group（n=17）and ETV〉6 months of live group（n=16）. We assessed postoperative neurodevelopmental outcomes using Gesell developmental diagnosis schedule which included gross motor, fine motor, adaptive, linguistic and personal-social functions.ResultsThere was statistical significance in neurodevelopmental outcomes between two groups（P﹤0.05）. Patients in ETV〉6 months of live group presented better outcome scores in all assessed domains than those in ETV≤6 months of live group（23.00±3.62 vs. 48.81±6.81; 25.94±3.07 vs.55.56±8.40; 15.00±3.06 vs.40.94±6.69; 20.00±3.06 vs. 45.81±6.81; 21.12±3.22 vs. 45.88±7.22）. Sixteen（100%） patients in ETV≤6 months of live group had severe neurodevelopmental disability whereas only one（6.25%） patient in ETV〉6 months of live group had severe neurodevelopmental disability.ConclusionsEndoscopic third ventriculostomy on infants with obstructive hydroceph-alus before six month of ages is associated with low operative success rate and poor neurodevelopmental outcomes.