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[儿童脑积水的外科治疗。I. 临床进展与死亡率]

[Surgical treatment of hydrocephalus in children. I. Clinical development and mortality].

作者信息

Colli B O, Starr E M, Martelli N

出版信息

Arq Neuropsiquiatr. 1981 Dec;39(4):396-407. doi: 10.1590/s0004-282x1981000400005.

Abstract

The authors analized the clinical evolution and the mortality of fifty seven children with hydrocephalus due to congenital malformation (41.1%), meningitis (36.8%) and tumors (21.1%), that were submitted to surgical treatment for hydrocephalus, from 1970 to 1980. Insertions of ventriculostomy reservoir and of external ventricular drainage were satisfactory used to control the expanding hydrocephalus in children with meningitis, that wait insertion of the valve. The use of hypothalamic ventriculostomy with catheter has showed satisfactory results in the treatment of children with hydrocephalus due to non inflammatory origin. Ventriculoatrial shunts were utilized in few cases but were useful in the treatment of hydrocephalus in children. The operative mortality rate was 25.7%. Ventriculoperitoneal shunts showed good results in the treatment of hydrocephalus in 89.4% of the cases in the immediate post-operative time and this number drop to 88.2% at the eighteen post-operative month. The overall mortality rate was 34%. At the end of the third post-operative month 27.3% of the survivors of the children with hydrocephalus due to congenital malformation and meningitis submitted to ventriculoperitoneal shunts showed normal neuromotor development and at the end of the second post-operative year this number increased to 50%. The operative mortality rate in this group was 25% and the majority of death occurred due to meningitis.

摘要

作者分析了1970年至1980年间57例因先天性畸形(41.1%)、脑膜炎(36.8%)和肿瘤(21.1%)导致脑积水并接受脑积水手术治疗的儿童的临床病程及死亡率。脑室造瘘贮液器置入和外部脑室引流在控制脑膜炎患儿等待瓣膜置入期间不断扩大的脑积水中使用效果良好。带导管的下丘脑脑室造瘘术在治疗非炎性起源的脑积水患儿中显示出满意的效果。很少使用脑室心房分流术,但对儿童脑积水治疗有用。手术死亡率为25.7%。脑室腹腔分流术在术后即刻治疗脑积水的89.4%的病例中效果良好,术后18个月这一数字降至88.2%。总死亡率为34%。在术后第三个月末,接受脑室腹腔分流术的因先天性畸形和脑膜炎导致脑积水的患儿幸存者中,27.3%显示神经运动发育正常,术后第二年末这一数字增至50%。该组手术死亡率为25%,大多数死亡是由脑膜炎所致。

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