神经内镜第三脑室底造瘘术联合脉络丛烧灼术治疗儿童脑积水的疗效分析

目的分析神经内镜第三脑室底造瘘术（ETV）联合脉络丛烧灼术（CPC）治疗儿童脑积水的临床治疗效果。方法回顾性分析2016年1月—2019年1月广东三九脑科医院神经外科收治的50例脑积水患儿的临床资料，依治疗方式不同分为观察组（n=26，ETV联合CPC）和对照组（n=24，ETV）。分析两组患儿治疗效果情况。结果观察组患儿在总有效率为96.1%，对照组患儿在总有效率为70.8% ，两组比较有统计学意义（P＜0.05）。其中观察组中因梗阻性脑积水行联合治疗其有效率为100%，因交通性脑积水性联合治疗其有效率为90%，两者对比无统计学意义（P>0.05）；对照组中因梗阻性脑积水行联合治疗其有效率为84.6%，因交通性脑积水性联合治疗其有效率为27.3%，两者对比无统计学意义（P>0.05）。观察组1例、对照组7例造瘘术后无效，后转为行脑室腹腔分流治疗。观察组出现1例硬膜下积液，1例气颅（2/26,7.7%），对照组1例癫痫、1例感染（2/24,8.3%），两组的并发症比较无统计学意义（P>0.05）；观察组患儿术后半年的平均Gesell发育商数均高于对照组，有统计学意义（P＜0.05）。结论神经内镜下第三脑室底造瘘术联合脉络丛烧灼术治疗儿童脑积水安全有效，显著改善患儿神经发育水平。

Objective To explore the therapeutic effect of endoscopic third ventriculostomy(ETV) combined with choroid plexus cauterization(CPC) for hydrocephalus in children. Methods The clinical data of 50 patients with hydrocephalus admitted to Department of Neurosurgery, Guangdong 999 Brain Hospital were analyzed retrospectively. The patients were divided into the observation group(ETV with CPC) in 26 patients and the control group(ETV) in 24 according to the surgical methods. The therapeutic effect of the two groups was analyzed. Results The total effective rate of children in the observation group was 96.1%, and that of children in the control group was 70.8%, which was statistically significant(P<0.05). In the observation group, the effective rate of combined treatment for obstructive hydrocephalus was 100%, and the effective rate of combined treatment for communicating hydrocephalus was 90%, with no statistical significance(P>0.05). In the control group, the effective rate of combined treatment for obstructive hydrocephalus was 84.6%, and the effective rate of combined treatment for communicating hydrocephalus was 27.3%. There was no significant difference between the two groups(P>0.05). 1 case in the observation group and 7 cases in the control group were invalid after ETV with or without CPC, and then underwent VP(ventriculoperitoneal shunt). The incidence of complications in both groups was no statistically significant(P>0.05). The average Gesell development quotient of children in the observation group was higher than that in the control group half a year after operation, with statistical significance(P<0.05). Conclusion ETV combined with CPC are safe and effective in the treatment of children hydrocephalus，and can significantly improve the neurodevelopmental level of children.