鞍上肿瘤患儿术后分流的危险因素：124 例患者的回顾性分析。
Risk factors for postresection shunting in children with suprasellar tumor: a retrospective analysis of 124 patients.
机构信息
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
出版信息
Childs Nerv Syst. 2022 May;38(5):939-945. doi: 10.1007/s00381-022-05498-4. Epub 2022 Mar 14.
OBJECTIVE
Hydrocephalus is one of the most significant comorbidities of pediatric suprasellar tumors. Up to 37.5-68.0% of patients were diagnosed with hydrocephalus at admission. However, after surgical resection of the tumor, 9.3-51.4% of the hydrocephalus will persist and require a ventriculoperitoneal shunt (VPS) surgery. The purpose of this study was to identify the risk factors associated with postresection shunting in children with suprasellar tumors.
METHODS
We conducted a retrospective analysis of children who underwent surgery for suprasellar tumors at our department from February 2011 to December 2020. We used univariate and multivariate analysis to screen the factors that might be correlated with postoperative shunt placement, taking into account patients' characteristics, tumor histology/size/calcification, the severity of preoperative hydrocephalus, the involvement of ventricles, external ventricular drainage (EVD) placement, postoperative intraventricular hematoma, the extent of resection, and other surgical details.
RESULTS
A total of 124 children who underwent surgery for suprasellar tumors were included in our study. Hydrocephalus was present in 55 patients (44.3%) at admission; 23 patients (18.5%) received VPS implantation after tumor removal. Univariate analysis showed that the involvement of ventricles (p = 0.002), moderate/severe preoperative hydrocephalus (p = 0.001), postoperative intraventricular hematoma (p = 0.005), and EVD implantation (p = 0.001) were significantly associated with postoperative VPS. Multivariate analysis confirmed that only ventricle involvement (p = 0.002; OR = 5.6; 95%CI 1.8-17.2) and intraventricular hematoma (p = 0.01; OR = 10.7; 95%CI 1.8-64.2) were independent risk factors for postresection shunting.
CONCLUSION
Ventricle involvement and intraventricular hematoma can be identified as independent predictors for postoperative shunting in pediatric suprasellar tumors.
目的
脑积水是儿童鞍上肿瘤最常见的合并症之一。高达 37.5-68.0%的患者在入院时被诊断为脑积水。然而，在肿瘤切除术后，9.3-51.4%的脑积水将持续存在并需要脑室-腹腔分流术（VPS）手术。本研究的目的是确定与儿童鞍上肿瘤切除术后分流相关的危险因素。
方法
我们对 2011 年 2 月至 2020 年 12 月在我科接受鞍上肿瘤手术的儿童进行了回顾性分析。我们使用单因素和多因素分析来筛选可能与术后分流有关的因素，考虑到患者的特征、肿瘤的组织学/大小/钙化、术前脑积水的严重程度、脑室受累情况、外引流（EVD）放置、术后脑室内血肿、切除程度和其他手术细节。
结果
共纳入 124 例接受鞍上肿瘤手术的儿童。入院时 55 例（44.3%）存在脑积水；23 例（18.5%）在肿瘤切除后接受 VPS 植入。单因素分析显示，脑室受累（p=0.002）、中重度术前脑积水（p=0.001）、术后脑室内血肿（p=0.005）和 EVD 植入（p=0.001）与术后 VPS 显著相关。多因素分析证实，仅脑室受累（p=0.002；OR=5.6；95%CI 1.8-17.2）和脑室内血肿（p=0.01；OR=10.7；95%CI 1.8-64.2）是术后分流的独立危险因素。
结论
脑室受累和脑室内血肿可被视为儿童鞍上肿瘤术后分流的独立预测因素。
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