儿童后颅窝肿瘤术后脑积水行永久性脑脊液分流的影响因素分析

Analysis of factors influencing permanent cerebrospinal fluid diversion for hydrocephalus after posterior fossa tumor surgery in children

目的探讨儿童后颅窝肿瘤切除术后因脑积水行永久性脑脊液分流的影响因素。方法回顾性分析南方医科大学珠江医院神经外科中心2011年1月至2022年12月收治的后颅窝肿瘤患儿的临床资料。根据患儿术后是否行永久性脑脊液分流,分为分流组和未分流组,比较两组患儿临床资料的差异。将单因素分析中差异有统计学意义的因素纳人多因素logistic回归模型中进行分析,确定术后需要永久性脑脊液分流的相关危险因素。结果共纳人患儿165例,术前脑积水110例(66.7%),术后行永久性脑脊液分流35例(21.2%)。单因素分析显示,与未分流组(130例)比较,分流组(35例)患儿术前脑间质水肿者占比较高[91.4%(32/35)对比73.1%(95/130)],术后首次外周血中性粒细胞与淋巴细胞比值(NLR)较高[M(Q_(1),Q_(3))分别为8.9(5.0,20.3)和5.7(3.4,11.1)],差异均具有统计学意义(均P<0.05);而两组患儿的性别、年龄、病程、术前脑积水、术前肿瘤播散、肿瘤位置、肿瘤病理学类型、肿瘤级别、肿瘤切除程度、术者、术后脑室系统积血、术前外周血白细胞计数、术前外周血NLR和术后首次外周血白细胞计数的差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,术前脑间质水肿(0R=5.29,95%CI:1.40~19.95,P=0.014)和术后首次外周血NLR高(0R=1.07,95%CI:1.02~1.11,P=0.002)均为术后需要行永久性脑脊液分流的重要危险因素。结论术前脑间质水肿和术后首次外周血NLR较高的后颅窝肿瘤患儿在肿瘤切除术后需行永久性脑脊液分流的风险较高。

Objective To explore the influencing factors of permanent cerebrospinal fluid diversion for hydrocephalus after posterior fossa tumor surgery in children.Methods The clinical data of children with posterior fossa tumors admitted to the Neurosurgery Center of Zhujiang Hospital of Southern Medical University from January 2011 to December 2022 were retrospectively analyzed.According to whether the children underwent permanent cerebrospinal fluid diversion after surgery,they were divided into the diversion group and the non-diversion group,and the differences in the clinical data between the two groups were analyzed.The factors that were statistically significant in the univariate analysis were included in the multivariate logistic regression analysis to determine the important risk factors for the need for permanent cerebrospinal fluid diversion after surgery.Results A total of 165 children were enrolled.Among them,110(66.7%)had preoperative hydrocephalus and 35(21.2%)underwent a postoperative permanent cerebrospinal fluid diversion.Univariate analysis showed that compared with the non-diversion group(130 cases),a higher percentage of children in the diversion group(35 cases)had preoperative interstitial cerebral edema[91.4%(32/35)vs.73.1%(95/130)],and the neutrophil-to-lymphocyte ratio(NLR)in the first postoperative peripheral blood examination was higher[M(Q_(1),Q_(3)):8.9(5.0,20.3)us.5.7(3.4,11.1)],and the differences were statistically significant(all P<0.05);whereas the differences in sex,age,disease duration,preoperative hydrocephalus,preoperative tumor dissemination,tumor location,pathological type of tumor,tumor grade,extent of tumor resection,operator,postoperative ventricular blood,preoperative peripheral white blood cell counts,preoperative peripheral blood NLR,or postoperative firsttime peripheral white blood cell counts between the two groups were not statistically significant(all P>0.05).Multivariate logistic regression analysis showed that both preoperative interstitial cerebral edema(OR=5.29,95%CI:1.40-19.95,P=0.014)and a high NLR in the first postoperative peripheral blood examination(0R=1.07,95%CI:1.02-1.11,P=0.002)were important risk factors for the need for permanent cerebrospinal fluid diversion after surgeryC.onclusionChildren with posterior fossa tumors who have preoperative interstitial cerebral edema and a high NLR in the first postoperative peripheral blood examination are at higher risk of needing permanent cerebrospinal fluid diversion after tumor surgery.