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目的通过分析接受脑室腹腔分流手术(VPS)的儿童脑积水患者的预后情况,探讨预后相关因素及其治疗措施。方法本研究共包括100例2006年至2010年接受VPS的儿童脑积水患者(3个月至15岁)。术后3个月至5年进行初次随访,对患者的人口学特征、临床表现、外科措施等资料进行分析。结果头颅增大、头痛、步态不稳为术前三大主要症状,分流术后87.5%患者头痛改善,头颅缩小者35.2%。在前三年随访中全部患者(各种程度)的脑室缩小率超过80%,脑室增大者1%~2%。随访期内患者自评或监护人针对患者症状评价的改善率为35.2%~87.5%,平均69%。分流术后各种并发症发生率为44%,死亡率为3%。结论分流手术的疗效需进行长期观察,CT或MRI显示脑室缩小是分流术后效果良好的直接证据,但不是唯一证据。在评价分流手术最终预后时不能忽略症状和体征的改善。
Objective To analyze the prognosis of children with hydrocephalus after intraventricular peritoneal shunt (VPS) and to explore the prognostic factors and treatment measures. Methods A total of 100 children with hydrocephalus (3 months to 15 years) receiving VPS from 2006 to 2010 were included in this study. After 3 months to 5 years of initial follow-up, the demographic characteristics of patients, clinical manifestations, surgical measures and other data were analyzed. Results Head increased, headache, unstable gait for the three main preoperative symptoms, postoperative shunt 87.5% of patients with headache to improve, 35.2% of those with reduced skull. During the first three years of follow-up, all patients (various degrees) had a reduction in ventricular volume over 80% and ventricular enlargement from 1% to 2%. During the follow-up period, patients ’self-evaluation or guardian’s evaluation of patients’ symptoms improved from 35.2% to 87.5%, with an average of 69%. The incidence of complications after shunt was 44%, the mortality rate was 3%. Conclusion The curative effect of shunt surgery needs to be observed for a long time. CT or MRI shows ventricular contraction is the direct evidence of the effect after shunt, but it is not the only evidence. The improvement in symptoms and signs can not be ignored in evaluating the final outcome of shunt surgery.