小儿神经外科疾病的单中心研究

Analysis of pediatric neurosurgical diseases:A single-center study

目的总结单中心小儿神经外科疾病的流行病学特征。方法回顾性分析2008年1月至2018年6月空军军医大学西京医院神经外科收治的5790例0~15岁神经外科疾病患儿的临床资料,分析不同疾病类型以及患者的年龄、性别、病变部位等临床特征的分布情况。结果5790例患儿中,先天性畸形2259例(39.0%)、肿瘤1561例(27.0%)、外伤性疾病953例(16.5%)、脑血管疾病360例(6.2%)、炎症性疾病159例(2.7%)、功能性疾病91例(1.6%)、其他疾病407例(7.0%)。男女比例为1.76∶1.00。各类疾病中,男性患儿所占比率均高于女性患儿(P<0.001)。总体发病高峰年龄为0~3岁,其中先天性畸形和肿瘤分别好发于0~3岁(42.9%)、13~15岁(26.3%)。最常见的3类先天性畸形分别为蛛网膜囊肿(29.6%)、先天性脑积水(28.2%)、脊髓拴系综合征(20.0%);蛛网膜囊肿患儿中,颞叶为其最常见部位(45.4%)。最常见的3类脑肿瘤分别为胶质瘤(19.7%)、颅咽管瘤(9.0%)、髓母细胞瘤(8.8%);脑肿瘤:脊髓肿瘤比例为5.61∶1.00;小脑幕上肿瘤:小脑幕下肿瘤的比例为1.73∶1.00;低级别肿瘤:高级别肿瘤的比例为1.67∶1.00。外伤中原发性颅脑损伤共365例(58.6%),其中脑挫裂伤占比最高(59.2%)。脑血管疾病中,自发性出血的占比最高(27.2%)。炎症性疾病中,炎性肉芽肿的占比最高(22.6%)。此外,随年龄的增长,先天性畸形的发生率逐渐下降,而脑血管病的发生率逐渐上升(均P<0.001)。结论小儿神经外科疾病具有独特的临床流行特征。先天性畸形和肿瘤较为好发,其中蛛网膜囊肿和胶质瘤的发病率最高。不同的疾病种类中,男性发病率均高于女性,且发病高峰年龄不同。

Objective To summarize the clinical epidemiological characteristics of pediatric neurosurgical diseases at a single center.Methods A total of 5790 children(≤15 years old)with neurosurgical diseases admitted to Department of Neurosurgery,Xijing Hospital,Air Force Medical University from January 2008 to June 2018 were retrospectively enrolled.Their clinical data were analyzed and included the distribution of various diseases and clinical characteristics such as age,gender and lesion location.Results All 5790 children included 2259 cases(39.0%)of congenital malformation,1561 cases of tumor(27.0%),953 cases of trauma(16.5%),360 cases of cerebrovascular disease(6.2%),159 cases of inflammation(2.7%),91 cases of functional disorder(1.6%)and 407 cases of other diseases(7.0%).The gender ratio(male∶female)was 1.76∶1.00.In all kinds of diseases,the proportion of male children was higher than that of female children,and the difference was statistically significant(P<0.001).The overall peak age of onset was 0-3 years old.Congenital malformations and tumors were predominant in 0-3 years old(42.9%)and 13-15 years old(26.3%),respectively.Three most frequent congenital malformations were arachnoid cyst(29.6%),hydrocephalus(28.2%)and tethered cord syndrome(20.0%).Temporal lobe was the most common site of arachnoid cyst(45.4%).Three most common tumors were glioma(19.7%),craniopharyngioma(9.0%)and medulloblastoma(8.8%).The ratios of brain tumors to spinal canal tumors,supratentorial tumors to infratentorial tumors and low-grade tumors to high-grade tumors were 5.61∶1.00,1.73∶1.00 and 1.67∶1.00,respectively.Primary brain injury(365 cases)accounted for 58.6%of traumatic diseases and 59.2%(the highest proportion)of primary brain injury was brain contusion and laceration.In cerebrovascular diseases,the proportion of spontaneous hemorrhage(27.2%)was the highest.The most common inflammatory disease was inflammatory granuloma(22.6%).In addition,with the increase of age,the incidence of congenital malformation decreased gradually,while the incidence of cerebrovascular diseases increased gradually(both P<0.001).Conclusions Pediatric neurosurgical diseases have unique clinical epidemic characteristics.Congenital malformations and tumors are more common,and the incidence of arachnoid cysts and gliomas seems to be the highest.In various diseases,the incidence of male is higher than that of female,and the peak ages are different.