儿童药物难治性癫痫迷走神经刺激术后的并发症分析

Analysis of postoperative complications of vagus nerve stimulation for pediatric refractory epilepsy

目的:分析儿童药物难治性癫痫患者行迷走神经刺激术(VNS)的术后并发症情况,并探讨并发症的处理措施。方法:回顾性分析2015年9月至2019年12月于首都医科大学附属北京儿童医院功能神经外科行VNS治疗,且随访时间≥6个月的294例儿童药物难治性癫痫患者的临床资料,分析患儿手术相关并发症的发生情况,总结其处理措施和效果。结果:294例患儿中,术后23例(7.8%)出现手术操作或硬件相关并发症,其中咽喉部并发症最常见,占4.4%(13/294),其他依次为切口浅表感染(2.0%,6/294)、切口深部感染(1.4%,4/294)、刺激器组件周围皮下血肿(0.7%,2/294)以及免疫排斥反应(0.3%,1/294)。6例术后发生切口浅表感染的患儿予抗感染治疗后局部症状消失;4例合并切口深部感染的患儿予去除VNS装置、抗感染治疗后,感染被有效控制;2例合并刺激器组件周围皮下血肿的患儿行加压包扎并换药后血肿消退;1例发生免疫排斥反应的患儿经取出全部VNS装置后症状消失;13例合并咽喉部并发症的患儿通过调节刺激器参数以及采用术后康复措施后症状消失。结论:儿童药物难治性癫痫VNS术后并发症的发生率低,其中咽喉部并发症和感染最多见。各项并发症经相应处理后效果满意。手术操作中诸多技术环节与术后并发症存在关联,规范化操作是预防并发症的关键因素。

Objective To analyze the postoperative complications of vagus nerve stimulation(VNS)in children with refractory epilepsy,and to explore the corresponding treatment strategies.Methods A retrospective study was conducted on the clinical data of 294 children with refractory epilepsy who were treated with VNS at Department of Functional Neurosurgery,Beijing Children′s Hospital,Capital Medical University from September 2015 to December 2019 and followed up for more than 6 months.Postoperative complications were documented.Corresponding treatment and outcomes were summarized.Results Among 294 patients,23 cases(7.8%)had postoperative complications related to operation or hardware,including throat-related complications(4.4%,13/294)which was mostly commonly observed,superficial incision infection(2.0%,6/294),deep incision infection(1.4%,4/294),subcutaneous hematoma around VNS device(0.7%,2/294)and immune rejection(0.3%,1/294).The local symptoms disappeared after anti-infection treatment in 6 children with superficial incision infection after operation.Among 4 children with deep incision infection,the infection was effectively controlled after removal of the VNS device and anti-infection treatment.In 2 children with subcutaneous hematoma around the stimulation device,the hematoma was resolved following pressure dressing and dressing change.In 1 child with immune rejection,the symptoms disappeared after all VNS devices were removed.In 13 children with throat complications,the symptoms disappeared after the programming of VNS and postoperative rehabilitation.Conclusions The incidence of postoperative complications of VNS in children with refractory epilepsy is low,and throat complications and infections are the most common.The outcomes of various complications are satisfactory after corresponding treatment.Many technical aspects in surgical operations are associated with postoperative complications,and the standardized operation is a key factor in the prevention of complications.