脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水临床分析

摘要

目的 探讨脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水的手术方法、安全性、并发症及临床转归.方法 收集我院2012年2月至2015年1月脑室内出血后脑积水并予脑室帽状腱膜下引流术的早产儿资料,分析治疗过程的安全性、治疗期间并发症的处理及治疗效果.结果 共入选12例患儿,均在床边行脑室帽状腱膜下引流术.患儿手术后均未出现颅内感染、出血、头皮感染.伤口愈合不良1例,囊肿穿刺部位渗液1例,引流管移位2例,手术后因呼吸暂停予呼吸机辅助通气24 h后撤机1例.5例患儿单纯通过帽状腱膜下引流即保持脑室稳定且逐步缩小,在术后1年拔除了引流管;2例患儿在术后10周行脑室腹腔分流术并去除帽状腱膜下引流管;4例患儿在帽状腱膜下引流术后10 ～12天开始行帽状腱膜下囊肿穿刺抽液,其中1例最终脑积水稳定,2例分别在10周和24周行脑室腹腔分流术,1例仍暂以囊肿穿刺抽液维持治疗中;1例患儿因合并其他疾病家长放弃治疗.结论 脑室帽状腱膜下引流术可床边操作,结合必要时的穿刺抽液,是治疗早产儿脑室内出血后脑积水简单、安全而有效的方法.%Objective To discuss the surgical techniques,safety,complications and clinical outcomes of ventriclosubgaleal shunts in the treatment of posthemorrhagic hydrocephalus of preterm infants.Methods Data of preterm infants suffered from posthemorrhagic hydrocephalus and received ventriculosubgaleal shunts treatment in our hospital from February 2012 to January 2015 were collected.Safety of the procedure,complications and efficacy of the treatment were analyzed.Results Total of twelve patients were enrolled.Ventriclosubgaleal shunt procedure was performed at the bedside.No intracranial infection,hemorrhage or scalp infection occurred after the procedure.One case had delayed healing of wound.One case had discharge from cyst puncture site.Two cases had displacement of the shunt tube.One case had apnea that was resolved after mechanical ventilation for 24 hours.Five cases had consistent improvement of hydrocephalus post ventriculosubgaleal shunt,with successful shunt removal after 1 year.Two cases accepted ventricle-peritoneal shunt 10 weeks after ventriculosubgaleal shunt procedure.Among the four patients who began to eceived subgaleal cyst puncture to release cerebrospinal fluid 10-12 days post ventriculosubgaleal shunt,one patient's hydrocephalus was eventually stabilized,two patients underwent ventriculo-peritoneal shunt procedure 10 and 24 weeks later,one patient currently is still receiving subgaleal cyst puncture therapy.Treatment of one patient was discontinued due to parental decision of terminating all treatments.Conclusions Ventriculosubgaleal shunts,combined with subgaleal cyst puncture when necessary,is a simple,safe and effective treatment for posthemorrhagic hydrocephalus and can be performed at the bedside.