幕上肿瘤患儿手术后行脑室-腹腔分流术危险因素分析

Risk factors analysis of ventriculoperitoneal shunt after supratentorial neoplasms surgery in children

目的 筛查幕上肿瘤患儿肿瘤切除术后因新发脑积水或原有脑积水进展而行脑室-腹腔分流术的危险因素。方法 纳入2011年1月至2021年1月于华中科技大学同济医学院附属同济医院行幕上肿瘤切除术的199例患儿,以社会人口学资料、病程与影像学资料、手术相关指标、脑积水发生和急性进展情况作为评价指标,采用单因素和多因素逐步法Logistic回归分析筛查术后行脑室-腹腔分流术的危险因素。结果 约7.54%(15/199)患儿术后需行脑室-腹腔分流术,其中14/15例为术后2周内新发脑积水或原有脑积水进展。Logistic回归分析显示,术前存在脑积水(OR=14.756,95%CI:3.451~63.089;P=0.000)、肿瘤邻近中线(OR=5.466,95%CI:1.409~21.203;P=0.014)、术中出血量大(OR=1.295,95%CI:1.016~1.650;P=0.037)是幕上肿瘤患儿手术后需行脑室-腹腔分流术的危险因素。结论幕上肿瘤切除术后并发脑积水或原有脑积水进展主要发生于术后2周内,对于术前合并脑积水、肿瘤邻近中线和术中出血量大的患儿应警惕术后新发脑积水或原有脑积水急性进展。

Objective To screen the risk factors for ventriculoperitoneal shunt(VPS)after tumor resection in children with supratentorial neoplasms due to new hydrocephalus or progression of existing hydrocephalus.Methods Total 199 children who underwent supratentorial neoplasms resection at Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,from January 2011 to January 2021 were included.Socio-demographic data,course of disease and imaging data,tumor resection-related indicators and hydrocephalus occurrence and progression were collected.The risk factors for the occurrence or progression of existing hydrocephalus after supratentorial neoplasms resection were analyzed by univariate and multivariate Logistic regression.Results Fifteen of 199 children(7.54%)with supratentorial tumors required VPS after surgery,of which 14 had new hydrocephalus or progression of existing hydrocephalus within 2 weeks after surgery.Logistic regression analysis showed the presence of preoperative coexisting hydrocephalus(OR=14.756,95%CI:3.451-63.089;P=0.000),tumor adjacent to the midline(OR=5.466,95%CI:1.409-21.203;P=0.014),and large intraoperative bleeding(OR=1.295,95%CI:1.016-1.650;P=0.037)were risk factors for the need of VPS in children with supratentorial tumors.Conclusions Development or progression of hydrocephalus after tumor resection in children with supratentorial neoplasms occurs mostly within 2 weeks after surgery.Children with preoperative coexisting hydrocephalus,tumor adjacent to the midline,and large intraoperative bleeding should be alerted to development and acute progression of hydrocephalus after surgery.