儿童幕下脑肿瘤术后脑积水行脑室腹腔分流术的危险因素分析

Risk factors of ventriculoperitoneal shunting for hydrocephalus after infratentorial brain tumor resection in children

目的研究儿童幕下脑肿瘤切除术后因脑积水进展或新发脑积水而需再行脑室-腹腔分流术的危险因素。方法收集2010年11月至2020年12月于华中科技大学同济医学院附属同济医院神经外科行肿瘤切除术的217例14岁以下幕下脑肿瘤患儿的临床资料, 其中男130例, 女87例, 患儿平均年龄为7.5岁, 分析术后需行脑室-腹腔分流术(VP分流术)患儿的临床特征, 总结术后行VP分流术的影响因素。连续变量以±s表示, 组间比较使用独立样本t检验;分类变量采用例数及百分比表示, 组间比较使用χ^(2)检验和Fisher精确检验。将单因素分析有统计学意义(P<0.05)的因素纳入多因素logistic回归分析确定术后行VP分流术的独立危险因素。结果 217例患儿中, 术前合并脑积水有167例(77.0%, 167/217), 28例(16.8%, 28/167)术后需行VP分流术;术前未合并脑积水50例(23.0%, 50/217)中仅有1例(2.0%, 1/50)术后新发脑积水需行VP分流术。术后需行VP分流的29例患儿中21例(72.4%, 21/29)术后2周内出现脑积水进展。术前合并脑积水患儿中有40例肿瘤切除术前先行脑室外引流缓解脑积水, 7例(17.5%, 7/40)需行VP分流术;127例行保守脱水治疗, 21例(16.5%, 21/127)行VP分流术, 比较术后行VP分流率差异并无统计学意义(P=0.887)。单因素及多因素logistic回归分析结果显示:患儿年龄>3岁(OR=0.187, P=0.005)、肿瘤位于第四脑室内(OR=5.814, P=0.001)和术中出血量(OR=1.480, P=0.021), 即年龄≤3岁、肿瘤位于第四脑室内和术中出血量是儿童幕下脑肿瘤术后行VP分流术的独立危险因素。术前合并脑积水不是术后行VP分流术的独立危险因素。结论幕下脑肿瘤合并脑积水患儿在肿瘤切除术前行保守治疗或钻孔引流术对术后是否需VP分流术无明确影响, 儿童幕下脑肿瘤切除术后脑积水多在术后2周内发生或进展而需行VP分流术, 对于≤3岁、肿瘤位于第四脑室内和术中出血量大的患儿应警惕术后脑积水的发生, 术中出血量是一个新的危险因素。

Objective To explore the risk factors for the necessity of further ventriculoperitoneal shunts due to a new-onset or progression of hydrocephalus after resecting infratentorial tumor in children.Methods From November 2010 to December 2020,clinical data were retrospectively reviewed for 217 children aged under 14 years with infratentorial tumors undergoing tumor resection.Clinical data were also analyzed for children requiring postoperative ventriculoperitoneal shunt(VP shunt)and the risk factors affecting postoperative VP shunt summarized.Continuous variables were described as±s and independent sample t-test was utilized for inter-group comparisons;categorical variables were expressed as number of cases and percentages.Andχ^(2) and Fisher exact tests were employed for inter-group comparisons.Factors statistically significant(P<0.05)for univariate analysis were included into multivariate Logistic regression analysis for determining independent risk factors for postoperative VP shunt.Results Among them,167(77.0%,167/217)had preoperative hydrocephalus and 28(16.8%,28/167)requires postoperative VP shunt.Among 50 children(23.0%,50/217)without preoperative hydrocephalus,only one(2.0%,1/50)had no need for postoperative VP shunt.Among 29 children requiring postoperative VP shunts,21 cases(72.4%,21/29)developed progressive hydrocephalus within 2 weeks post-resection.Among 167 children with preoperative hydrocephalus,40 cases underwent external ventricular drainage(EVD)pre-resection for relieving hydrocephalus and 7 children(17.5%,7/40)had postoperative VP shunt.The remaining 127 children received conservative dehydration and 21(16.5%,21/127)required postoperative VP shunt.And there was no statistical difference between two groups(P=0.887).The results of univariate and multivariate Logistic regression analyses revealed that age>3 years(OR=0.187,P=0.005),tumor in the fourth ventricle(OR=5.814,P=0.001)and intraoperative hemorrhage(OR=1.480,P=0.021)were independent risk factors for postoperative VP shunting of infratentorial tumor in children.Preoperative hydrocephalus was not an independent risk factor for postoperative VP shunt.Conclusions For children with preoperative hydrocephalus,conservative treatment or EVD pre-resection has no definite impact upon the necessity of postoperative VP shunt.After infratentorial tumor resection,hydrocephalus occurring or progressing within 2 weeks requires VP shunt.Age≤3 years,tumor in the fourth ventricle and intraoperative hemorrhage are independent risk factors for postoperative VP shunting of infratentorial tumor in children.Intraoperative hemorrhage is a brand-new factor.