脑室-腹腔分流术治疗儿童结核性脑膜炎脑积水的疗效分析:脑积水脑室腹腔分流术

　　[摘要] 目的 分析脑室-腹腔分流术（VPS）治疗儿童结核性脑膜炎脑积水（TBMH）的临床疗效。 方法 选取TBMH患儿45例，所有患儿均行VPS治疗。记录患儿年龄、手术前后GCS评分、TBM分级、脑积水的类型和程度、术前抗结核治疗时间、术后恢复情况和术后并发症情况。分析患儿术后的疗效，同时比较疗效好和疗效差患儿参数差异。 结果 治疗效果好27例（60%），效果较差18例（40%）；术后近期出现并发症7例，发生率为15.6%。与疗效差患儿相比，疗效好患儿术前GCS评分较高、抗结核治疗时间较长、TBM分级较低，差异有统计学意义（P < 0.05）。 结论 VPS是一种有效治疗儿童TBMH的方法，其疗效可能与术前GCS评分、抗结核治疗时间、TBM分级有关。
　　[关键词] 脑室-腹腔分流术；结核性；脑膜炎；脑积水；儿童
　　[中图分类号] R529.3 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0051-02
　　
　　Analysis of curative effect on ventriculo-peritoneal shunt in the treatment of childhood tuberculous meningitis hydrocephalus
　　FENG Shubin LU Shan QI Lin
　　Department of Neurosurgery, Zhengzhou Children"s Hospital in He"nan Province, Zhengzhou 450053, China
　　[Abstract] Objective To analyze the clinical effect of ventriculo-peritoneal shunt (VPS) in the treatment of childhood tuberculous meningitis hydrocephalus (TBMH). Methods Forty five cases of children with TBMH were chosen. All the children were given the treatment of VPS. The children"s age, GCS scores before and after the operation, TBM classifications, the types and levels of hydrocephalus, the preoperative treatment time of anti-tuberculosis, the recovery conditions after operation and the complications after operation were recorded. The postoperative effects of children were analyzed, at the same time, the parametric differences among better effects and worse effects in children were compared. Results There were 27 cases (60%) of good curative effects and 18 cases (40%) of worse effects; the postoperative short-term complications occurred in 7 cases, with the incidence of 15.6%. Compared with the children with worse effects, the preoperative GCS scores of children with better effects were higher, the treatment time of anti-tuberculosis was longer, TBM classifications were lower, the differences were statistically significant (P ＜ 0.05). Conclusion VPS is an effective way in the treatment of childhood TBMH, its effects may be connected with preoperative GCS scores, the treatment time of anti-tuberculosis and TBM classifications.
　　[Key words] Ventriculo-peritoneal shunt; Tuberculous; Meningitis; Hydrocephalus; Children
　　脑积水是指由于脑脊液循环通路阻塞使脑脊液在颅内大量积聚，而导致脑室进行性扩大的一种疾病，根据阻塞原因分为梗阻性脑积水和交通性脑积水。结核性脑膜炎脑积水（tuberculous meningitis hydrocephalus，TBMH）是小儿结核性脑膜炎常见的并发症，发生率可达48%，多为梗阻性脑积水[1]。解除梗阻原因是TBMH最理想的治疗方法，但成功率不高，如何有效治疗TBMH一直是儿科临床医生十分头疼的问题。目前，脑室-腹腔分流术（ventriculoperitoneal shunting，VPS）是儿童脑积水的最常用治疗方法之一，其可以解除脑脊液循环障碍，使脑脊液的分泌与吸收得到平衡，降低颅内高压，达到治疗脑积水的目的[2]，但应用VPS治疗儿童TBMH的时机和疗效仍存在争议。本研究通过分析VPS治疗45例儿童TBMH的临床资料，来探讨VPS治疗儿童TBMH的疗效。