神经内镜下第三脑室造瘘治疗儿童梗阻性脑积水对患儿神经功能的影响

Effect of third ventriculostomy under neuroendoscopy on neurological function in children with obstructive hydrocephalus

目的探讨神经内镜下第三脑室造瘘治疗儿童梗阻性脑积水的效果。方法选取2015年1月至2017年12月在驻马店市中心医院治疗的38例梗阻性脑积水患儿,其中男20例,女18例;<1岁4例,1~3岁17例,>3~6岁17例;给予神经内镜下第三脑室造瘘治疗,观察治疗效果,采用Gesell儿童智力发育诊断量表评估脑认知功能。结果38例梗阻性脑积水患儿经治疗后,81.58%(31/38例)患儿改善,10.53%(4/38例)患儿无变化,7.89%(3/38例)患儿加重。术后1个月、3个月和6个月以育商(DQ)评分分别为(57.20±5.81)分、(75.12±6.02)分和(80.43±7.00)分,较术前[(50.12±6.11)分]明显升高(t=6.933、8.192、10.033,均P<0.05),其中术后6个月为(80.43±7.00)分,明显高于术后1个月和3个月(t=5.192、7.022,均P<0.05)。术后1个月、3个月和6个月脑室额角宽度分别为(37.82±6.01)mm、(38.00±5.89)mm和(37.03±5.25)mm,较术前[(44.01±5.61)mm]明显降低(F=24.292,P<0.05)。术后1个月、3个月和6个月第三脑室宽度分别为(16.89±3.82)mm、(16.72±4.10)mm和(16.11±4.11)mm,较术前[(21.02±4.37)mm]明显降低(F=19.143,P<0.05)。术后1个月、3个月和6个月肾上腺髓质素和神经元特异烯醇化酶明显较术前降低(F=45.281、11.022,均P<0.05);术后无严重并发症发生。结论神经内镜下第三脑室造瘘治疗儿童梗阻性脑积水有较好的效果,改善了患儿认知功能。

Objective To explore the effect of third ventriculostomy under neuroendoscopy in the treatment of children with obstructive hydrocephalus. Methods Thirty-eight cases of obstructive hydrocephalus treated at Zhumadian Central Hospital from January 2015 to December 2017 were selected, and among them there were 20 males and 18 females, aged <12 months in 4 cases, 1-3 years in 17 cases and 3-6 years in 17 cases.The children were treated by third ventriculostomy under neuroendoscopy, the therapeutic effect was observed, and the brain cognitive function was evaluated by Gesell child intelligence development diagnostic scale. Results After treatment, 81.58%(31/38 cases) of children were improved, the conditions of 10.53%(4/38 cases) of patients did not change, and 7.89%(3/38 cases) of patients got aggravated.The development quotient(DQ) scores of 1 month, 3 months and 6 months after operation were (57.20±5.81) scores,(75.12±6.02) scores and (80.43±7.00) scores, respectively, which were signi-ficantly higher than those of the preoperative scores [(50.12±6.11) scores](t=6.933, 8.192, 10.033, all P<0.05), and the DQ scores at 6 months after operation were (80.43±7.00), which were significantly higher than those of 1 month and 3 months after operation (t=5.192, 7.022, all P<0.05). The width of ventricle frontal horn at 1, 3 and 6 months after operation was (37.82±6.01) mm,(38.00±5.89) mm and (37.03±5.25) mm, respectively, which was significantly lower than that of preoperative width [(44.01±5.61) mm](F=24.292, P<0.05). The width of third ventricle at 1, 3 and 6 months after operation was (16.89±3.82) mm,(16.72±4.10) mm and (16.11±4.11) mm, respectively, which was significantly lower than that of preoperative width [(21.02±4.37) mm](F=19.143, P<0.05). The levels of adrenomedullin and neuron specific enolase decreased significantly at 1 month, 3 months and 6 months after operation (F=45.281, 11.022, all P<0.05). No serious complications occurred. Conclusions Third ventriculostomy under neuroendoscopy is effective in treating obstructive hydrocephalus in children and may improve the cognitive function in children.