外科治疗自发性脑室出血患儿的疗效分析
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摘要
目的探讨婴幼儿自发性脑室出血的外科治疗方法及疗效。方法回顾性分析20例自发性脑室出血患儿的临床资料,根据具体病情分别进行腰椎穿刺术、腰大池引流术、脑室外引流术和脑室联合腰大池引流术。所有患儿随访6个月至2年,观察其疗效。结果 2例行反复腰椎穿刺术、5例行持续腰大池引流术者,均痊愈;持续行脑室外引流术者10例,7例痊愈,3例好转;行脑室联合腰大池引流术者3例,2例痊愈,1例好转;本组中无死亡病例。结论婴幼儿脑室出血应及时进行外科治疗,具体手术方式应依据出血部位及出血量来决定,如治疗及时、术式适宜,则预后良好。
Objective To explore the surgical treatment and efficacy of spontaneous intraventricular hemorrhage in infants and young children. Methods Retrospective analysis was performed for 20 cases with spontaneous intraventricular hemorrhage.The different operations were selected according to specific diseases:(1)Lumbar puncture;(2)Lumbar cistern drainage;(3)External ventricular drainage;(4)External ventricle drainage plus lumbar cistern drainage.The follow-up period was from 6 months to 2 years. Results Two cases with repeated lumbar puncture and 5 cases with lumbar cistern drainage were cured.Among 10 cases with external ventricular drainage,they were cured(n=7) and improved significantly(n=3).Among 3 cases with external ventricle drainage plus lumbar cistern drainage,they were cured(n=2) and improved significantly(n=1).There was no case of mortality. Conclusion Infants and young children with intraventricular hemorrhage should be operated timely without delay.The choice of surgical operation depends on hemorrhagic site and amount of hemorrhage.Most patients have a good prognosis under proper treatment and appropriate operation.
Objective To explore the surgical treatment and efficacy of spontaneous intraventricular hemorrhage in infants and young children. Methods Retrospective analysis was performed for 20 cases with spontaneous intraventricular hemorrhage.The different operations were selected according to specific diseases:(1)Lumbar puncture;(2)Lumbar cistern drainage;(3)External ventricular drainage;(4)External ventricle drainage plus lumbar cistern drainage.The follow-up period was from 6 months to 2 years. Results Two cases with repeated lumbar puncture and 5 cases with lumbar cistern drainage were cured.Among 10 cases with external ventricular drainage,they were cured(n=7) and improved significantly(n=3).Among 3 cases with external ventricle drainage plus lumbar cistern drainage,they were cured(n=2) and improved significantly(n=1).There was no case of mortality. Conclusion Infants and young children with intraventricular hemorrhage should be operated timely without delay.The choice of surgical operation depends on hemorrhagic site and amount of hemorrhage.Most patients have a good prognosis under proper treatment and appropriate operation.
引文
1 张庆江,马骁,孙宁,等.婴儿自发性脑室出血诊治[J].临床小儿外科杂志,2005,4(4):241 — 243.Zhang QJ,Ma X,Sun N,et al.Diagnosis and therapy of spontaneous ventricular hemorrhage in infants[J].J Clin Ped Sur,2005,4(4):241 — 243.
2 魏中南,张庆江,詹江华,等.晚发性维生素K缺乏性颅内出血外科治疗316例[J].临床小儿外科杂志,2016,15(6):594 — 597.DOI:10.3969/j.issn.1671 — 6353.2016.06.019.Wei ZN,Zhang QJ,Zhan JH,et al.Surgical treatment for late vitamin K deficiency intracranial hemorrhage:a report of 316 cases[J].J Clin Ped Sur,2016,15(6):594 — 597.DOI:10.3969/j.issn.1671 — 6353.2016.06.019.
3 Ozdemir MA,Karakukcu M,Per H,et al.Late-type vitamin K deficiency bleeding:experience from 120 patients[J].Childs Nerv Syst,2012,28(2):247 — 251.DOI:10.1007/s00381 — 011 — 1575 — x.
4 Karaci M,Toroslu E,Karsli T,et al.Intracranial haemorrhage due to late-onset vitamin K deficiency[J].HK J Paediatr,2015,20 (2):80 — 85.
5 陈文杰,陈龙钦,叶金练,等.晚发型维生素K缺乏症致颅内出血34例临床治疗体会[J].中国临床神经外科杂,2018,23(2):109 — 111.DOI:10.13798/j.issn.1009 — 153X.2018.02.016.Chen WJ,Chen LQ,Ye JL,et al.Clinical experience for late vitamin K deficiency intracranial hemorrhage :a report of 34 cases [J].Chin J Clin Neurosurg,2018,23(2):109 — 111.DOI:10.13798/j.issn.1009 — 153X.2018.02.016.
6 Mukerji A,Shah V,Shah PS.Periventricular//intraventricular hemorrhage and neurodevelopmental outcomes:ameta-analysis[J].Pediatrics,2015,136(6):1132 — 1143.DOI:10.1542/peds.2015 — 0944.
7 Davis AS,Hintz SR,Goldstein RF,et a1.Outcomes of extremely preterm infants following severe intracranial hemorrhage[J].J Perinatol,2014,34(3):203 — 208.DOI:10.1038/jp.2013.162.
8 Logan JW,Westm SJ.Allred EN,et a1.Antecedents of perinatal cerebral white matter damage with and without intraventricular hemorrhage in very preterm newborns[J].Pediatr Neurol,2013,49(2):88 — 96.DOI:10.1016/j.pediatrneurol.2013.03.018.
9 Radic JA,Vincer M,McNeely PD.Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010[J].J Neurosurg Pediatr,2015,15(6):580 — 588.DOI:10.3171/2014.11PEDS14364.
10 Christian EA,Jin DL,Attenello F,et al.Thends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the united states,2000 — 2010[J]J Neurosurg Pediats,2016,17(3):260 — 269.DOI:10.3171/2015.7.PEDS15140.
11 钱虎飞,魏嘉,刘瑜,等.早期脑室外引流术治疗早产儿或低出生体重儿生发基质-脑室内出血[J].中华神经外科杂志,2016,32(9):886 — 889.DOI:10.3760/j.issn.1001 — 2346.2016.09.007.Qian HF,Wei J,Liu Y,et al.Early external ventricular drainage for the treatment of premature/low birth weight neonates with germinal matrix intraventricular hemorrhage[J].Chin J Neurosurg,2016,32(9):886 — 889.DOI:10.3760/j.issn.1001 — 2346.2016.09.007.
12 丁培源,张文川,王旭辉.脑室外引流联合腰大池引流治疗高血压脑室出血临床观察[J].解放军医药杂志,2017,29(11):22 — 25.DOI:10.3969/j.issn.2095 — 140X.2017.11.006.Ding PY,Zhang WC,Wang XH.Clinical observation of external ventricular drainage combined with lumbar cistern drainage in treatment of patients with hypertensive intraventricular hemorrhage[J].Med & Pharm J Chin PLA,2017,29(11):22 — 25.DOI:10.3969/j.issn.2095 — 140X.2017.11.006.
13 Wilson TJ,Stetler WR,Davis MC.Intraventricular hemorrhage is associated with early hydrocephalus,symptomatic vasospasm,and poor outcome in aneurismal subarachnoid hemorrhage[J].J Neurol Surg A Cent Eur Neurosurg,2015,76(2):126 — 132.DOI:10.1055/s — 0034 — 1394189.
14 Idris Z,Raj J,Abdullah JM.Early experience in endoscopic management of massive intracerebral haemorrhage with literature review[J].Asian J Neurosurg,2014,9(3):124 — 129.DOI:10.4103/1793 — 5482.142731.
15 余梦楠,黄柳明,刘钢,等.Ommaya囊埋植治疗早产儿脑室内出血后脑积水实施中的管理[J].中国新生儿杂志,2013,28(1);36 — 38.DOI:10.3969/j.issn.1673 — 6710.2013.01.011.Yu MN,Huang LM,Liu G,et al.Management of posthemorragic hydrocephalus in premature infants with Ommaya cyst implantation[J].Chin J Neonatol,2013,28(1):36 — 38.DOI:10.3969/j.issn.1673 — 6710.2013.01.011.
16 Bin NS,Ahmad M.Ommaya reservoir infection rate:a 6-year retrospective cohort study of Ommaya reservoir in pediatrics[J].Childs Nerv Syst,2015,31(1):29 — 36.DOI:10.1007/s00381 — 014 — 2561 — x.
17 王晓军,卞杰勇,路阳,等.经额锁孔入路手术治疗重型脑室出血的疗效[J].临床神经外科杂志,2017,14(1):13 — 16.DOI:10.3969/j.issn.1672 — 7770.2017.01.004.Wang XJ,Bian JY,Lu Y,et al.Preliminary study on frontal keyhole approach surgery for severe intraventricular hemorrhage[J].J Clin Neurosurg,2017,14(1):13 — 16.DOI:10.3969/j.issn.1672 — 7770.2017.01.004.
18 罗明,段发亮,吴京雷,等.神经导航辅助内镜技术治疗自发性颅内出血142例经验总结[J].中华外科杂志,2017,55(2):159 — 160.DOI:10.3760/j.issn.0529 — 5815.2017.02.017.Luo M,Duan FL,Wu JL,et al.Experience of neuronavigation-assisted endoscopic neurosurgery for spontaneous intracranial hemorrhage in 142 cases[J].Chin J Surg,2017,55(2):159 — 160.DOI:10.3760/j.issn.0529 — 5815.2017.02.017.
2 魏中南,张庆江,詹江华,等.晚发性维生素K缺乏性颅内出血外科治疗316例[J].临床小儿外科杂志,2016,15(6):594 — 597.DOI:10.3969/j.issn.1671 — 6353.2016.06.019.Wei ZN,Zhang QJ,Zhan JH,et al.Surgical treatment for late vitamin K deficiency intracranial hemorrhage:a report of 316 cases[J].J Clin Ped Sur,2016,15(6):594 — 597.DOI:10.3969/j.issn.1671 — 6353.2016.06.019.
3 Ozdemir MA,Karakukcu M,Per H,et al.Late-type vitamin K deficiency bleeding:experience from 120 patients[J].Childs Nerv Syst,2012,28(2):247 — 251.DOI:10.1007/s00381 — 011 — 1575 — x.
4 Karaci M,Toroslu E,Karsli T,et al.Intracranial haemorrhage due to late-onset vitamin K deficiency[J].HK J Paediatr,2015,20 (2):80 — 85.
5 陈文杰,陈龙钦,叶金练,等.晚发型维生素K缺乏症致颅内出血34例临床治疗体会[J].中国临床神经外科杂,2018,23(2):109 — 111.DOI:10.13798/j.issn.1009 — 153X.2018.02.016.Chen WJ,Chen LQ,Ye JL,et al.Clinical experience for late vitamin K deficiency intracranial hemorrhage :a report of 34 cases [J].Chin J Clin Neurosurg,2018,23(2):109 — 111.DOI:10.13798/j.issn.1009 — 153X.2018.02.016.
6 Mukerji A,Shah V,Shah PS.Periventricular//intraventricular hemorrhage and neurodevelopmental outcomes:ameta-analysis[J].Pediatrics,2015,136(6):1132 — 1143.DOI:10.1542/peds.2015 — 0944.
7 Davis AS,Hintz SR,Goldstein RF,et a1.Outcomes of extremely preterm infants following severe intracranial hemorrhage[J].J Perinatol,2014,34(3):203 — 208.DOI:10.1038/jp.2013.162.
8 Logan JW,Westm SJ.Allred EN,et a1.Antecedents of perinatal cerebral white matter damage with and without intraventricular hemorrhage in very preterm newborns[J].Pediatr Neurol,2013,49(2):88 — 96.DOI:10.1016/j.pediatrneurol.2013.03.018.
9 Radic JA,Vincer M,McNeely PD.Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010[J].J Neurosurg Pediatr,2015,15(6):580 — 588.DOI:10.3171/2014.11PEDS14364.
10 Christian EA,Jin DL,Attenello F,et al.Thends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the united states,2000 — 2010[J]J Neurosurg Pediats,2016,17(3):260 — 269.DOI:10.3171/2015.7.PEDS15140.
11 钱虎飞,魏嘉,刘瑜,等.早期脑室外引流术治疗早产儿或低出生体重儿生发基质-脑室内出血[J].中华神经外科杂志,2016,32(9):886 — 889.DOI:10.3760/j.issn.1001 — 2346.2016.09.007.Qian HF,Wei J,Liu Y,et al.Early external ventricular drainage for the treatment of premature/low birth weight neonates with germinal matrix intraventricular hemorrhage[J].Chin J Neurosurg,2016,32(9):886 — 889.DOI:10.3760/j.issn.1001 — 2346.2016.09.007.
12 丁培源,张文川,王旭辉.脑室外引流联合腰大池引流治疗高血压脑室出血临床观察[J].解放军医药杂志,2017,29(11):22 — 25.DOI:10.3969/j.issn.2095 — 140X.2017.11.006.Ding PY,Zhang WC,Wang XH.Clinical observation of external ventricular drainage combined with lumbar cistern drainage in treatment of patients with hypertensive intraventricular hemorrhage[J].Med & Pharm J Chin PLA,2017,29(11):22 — 25.DOI:10.3969/j.issn.2095 — 140X.2017.11.006.
13 Wilson TJ,Stetler WR,Davis MC.Intraventricular hemorrhage is associated with early hydrocephalus,symptomatic vasospasm,and poor outcome in aneurismal subarachnoid hemorrhage[J].J Neurol Surg A Cent Eur Neurosurg,2015,76(2):126 — 132.DOI:10.1055/s — 0034 — 1394189.
14 Idris Z,Raj J,Abdullah JM.Early experience in endoscopic management of massive intracerebral haemorrhage with literature review[J].Asian J Neurosurg,2014,9(3):124 — 129.DOI:10.4103/1793 — 5482.142731.
15 余梦楠,黄柳明,刘钢,等.Ommaya囊埋植治疗早产儿脑室内出血后脑积水实施中的管理[J].中国新生儿杂志,2013,28(1);36 — 38.DOI:10.3969/j.issn.1673 — 6710.2013.01.011.Yu MN,Huang LM,Liu G,et al.Management of posthemorragic hydrocephalus in premature infants with Ommaya cyst implantation[J].Chin J Neonatol,2013,28(1):36 — 38.DOI:10.3969/j.issn.1673 — 6710.2013.01.011.
16 Bin NS,Ahmad M.Ommaya reservoir infection rate:a 6-year retrospective cohort study of Ommaya reservoir in pediatrics[J].Childs Nerv Syst,2015,31(1):29 — 36.DOI:10.1007/s00381 — 014 — 2561 — x.
17 王晓军,卞杰勇,路阳,等.经额锁孔入路手术治疗重型脑室出血的疗效[J].临床神经外科杂志,2017,14(1):13 — 16.DOI:10.3969/j.issn.1672 — 7770.2017.01.004.Wang XJ,Bian JY,Lu Y,et al.Preliminary study on frontal keyhole approach surgery for severe intraventricular hemorrhage[J].J Clin Neurosurg,2017,14(1):13 — 16.DOI:10.3969/j.issn.1672 — 7770.2017.01.004.
18 罗明,段发亮,吴京雷,等.神经导航辅助内镜技术治疗自发性颅内出血142例经验总结[J].中华外科杂志,2017,55(2):159 — 160.DOI:10.3760/j.issn.0529 — 5815.2017.02.017.Luo M,Duan FL,Wu JL,et al.Experience of neuronavigation-assisted endoscopic neurosurgery for spontaneous intracranial hemorrhage in 142 cases[J].Chin J Surg,2017,55(2):159 — 160.DOI:10.3760/j.issn.0529 — 5815.2017.02.017.