[1]纪文元,梁平,李禄生,等.早期腰大池持续脑脊液外引流术在儿童后颅窝肿瘤切除术中的应用[J].第三军医大学学报,2018,40(05):454-458.
 JI Wenyuan,LIANG Ping,LI Lusheng,et al.Application of early continuous lumbar cerebrospinal fluid drainage in children after resection of posterior cranial fossa tumors[J].J Third Mil Med Univ,2018,40(05):454-458.
点击复制

早期腰大池持续脑脊液外引流术在儿童后颅窝肿瘤切除术中的应用(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第05期
页码:
454-458
栏目:
临床医学
出版日期:
2018-03-15

文章信息/Info

Title:
Application of early continuous lumbar cerebrospinal fluid drainage in children after resection of posterior cranial fossa tumors
作者:
纪文元梁平李禄生翟瑄周渝冬
重庆医科大学附属儿童医院神经外科,儿童发育疾病研究教育部重点实验室,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室
Author(s):
JI Wenyuan LIANG Ping LI Lusheng ZHAI Xuan ZHOU Yudong

Department of Neurosurgery, Key Laboratory of Child Development and Disorders of Ministry of Education, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, China

关键词:
腰大池引流后颅窝肿瘤脑积水颅内感染皮下积液
Keywords:
lumbar cerebrospinal fluid drainage posterior cranial fossa tumors hydrocephalus intracranial infection subcutaneous effusion
分类号:
R726.15; R730.56; R739.41
文献标志码:
A
摘要:

目的    探讨早期采用腰大池持续脑脊液外引流术(continuous lumbar cerebrospinal fluid drainage,CLCFD)对儿童后颅窝肿瘤切除术后的治疗效果。方法    回顾性分析重庆医科大学附属儿童医院神经外科2013年1月到2016年7月收治的137例合并脑积水的后颅窝肿瘤患儿术后情况。研究分2组:CLCFD组(63例)在肿瘤切除术后即刻行CLCFD;常规治疗组(74例)在肿瘤切除术后行连续腰椎穿刺。比较两组患者的治疗结果。结果    与常规治疗组比较,CLCFD患儿颅内感染率(P=0.031)、皮下积液发生率(P=0.006)、脑积水发生率(P=0.036)显著降低,术后发热>7 d(P<0.01)、颅内感染者抗生素使用>10 d(P=0.021)例数显著减少。结论    在后颅窝肿瘤术后早期采用CLCFD能减少患儿颅内感染、脑积水、皮下积液的发生率,缩短发热时间和抗生素的使用时间,手术简便、创伤小、并发症少,值得临床广泛应用。

Abstract:

Objective    To investigate the efficacy of early continuous lumbar cerebrospinal fluid drainage (CLCFD) in children after the resection of posterior cranial fossa tumors. Methods    A retrospective study was carried out on 137 children suffering from posterior cranial fossa tumor with hydrocephalus admitted in our department from January 2013 to July 2016. Their clinical data and postoperative therapeutic experience were collected and analyzed. The children were divided into CLCFD group (n=63, undergoing CLCFD immediately after tumor resection) and conventional group (n=74, accepting routine lumbar puncture postoperatively). The efficacy was observed and compared between the 2 groups. Results    Compared with the conventional group, the CLCFD group had significantly lower incidence rates of intracranial infection (P=0.031), subcutaneous hydrops (P=0.006), and hydrocephalus (P=0.036), and decreased ratios of those with postoperative fever over 7 d (P<0.01) and usage of antibiotics for over 10 d due to intracranial infection (P=0.021). Conclusion    Early CLCFD after resection of posterior cranial fossa tumor can reduce the incidence of intracranial infection, hydrocephalus and subcutaneous hydrops, shorten the duration of fever and decrease the usage of antibiotics. The approach is easy to operate, with mild trauma and less complications, and worthy of extensive application in clinical practice.

参考文献/References:

[1]SCHIJMAN E, PETER J C, REKATE H L, et al. Management of hydrocephalus in posterior fossa tumors: how, what, when[J]. Childs Nerv Syst, 2004, 20(3): 192-194. DOI:10.1007/s0038100309004.
[2]ZHOU D, ZHANG Y, LIU H, et al. Epidemiology of nervous system tumors in children: a survey of 1,485 cases in Beijing Tiantan Hospital from 2001 to 2005[J]. Pediatr Neurosurg, 2008, 44(2): 97-103. DOI:10.1159/000113110.
[3]MANGRAM A J, HORAN T C, PEARSON M L, et al. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee[J]. Infect Control Hosp Epidemiol, 1999, 20(4): 250-278. DOI:10.1086/501620.
[4]DIRINGER M N, REAVEN N L, FUNK S E, et al. Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients[J]. Crit Care Med, 2004, 32(7): 1489-1495. DOI:10.1097/01.ccm.0000129484.61912.84.
[5]FROSINI M, SESTI C, VALOTI M, et al. Rectal temperature and prostaglandin E2 increase in cerebrospinal fluid of conscious rabbits after intracerebroventricular injection of hemoglobin[J]. Exp Brain Res, 1999, 126(2): 252-258. DOI:10.1007/s002210050734.
[6]任晓辉, 张扬, 高之宪, 等. 神经外科术后颅内感染的影响因素及风险预测分析[J]. 中华神经外科杂志, 2015, 31(10): 992-996. DOI:10.3760/cma.j.issn.10012346. 2015.10.006.
REN X H, ZHANG Y, GAO Z X, et al. Influencing factors of intracranial infection and risk prediction analysis after neurosurgical operation[J]. Chin J Neurosurg, 2015, 31(10): 992-996. DOI:10.3760/cma.j.issn.10012346.2015.10.006.
[7]ABU HAMDEH S, LYTSY B, RONNEENGSTRM E. Surgical site infections in standard neurosurgery procedures—a study of incidence, impact and potential risk factors[J]. Br J Neurosurg, 2014, 28(2): 270-275. DOI:10.3109/02688697.2013.835376.
[8]林宝利, 蒲珂, 王红光, 等. 儿童后颅窝肿瘤术后颅内感染原因分析及诊治[J]. 中华神经外科疾病研究杂志, 2015, 14(6): 497-500.
LIN B L, PU K, WANG H G, et al. Intracranial infections of posterior fossa tumors craniotomy in children: Causes and treatment[J]. Chin J Neurosurg Dis Res, 2015, 14(6): 497-500.
[9]江常震, 吴喜跃, 林志雄, 等. 儿童第四脑室肿瘤显微外科治疗及手术后并发症的预防[J]. 中国神经肿瘤杂志, 2011, 9(3): 189-193.
JIANG C Z, WU X Y, LIN Z X, et al. Microsurgery of forth ventricle tumors and the prevention of postoperative complications[J]. Chin J NeuroOncol, 2011, 9(3): 189-193.
[10]CHIANG H Y, KAMATH A S, POTTINGER J M, et al. Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy[J]. J Neurosurg, 2014, 120(2): 509-521. DOI:10.3171/2013.9.JNS13843.
[11]KOURBETI I S, VAKIS A F, ZIAKAS P, et al. Infections in patients undergoing craniotomy: risk factors associated with postcraniotomy meningitis[J]. J Neurosurg, 2015, 122(5): 1113-1119. DOI:10.3171/2014.8.JNS132557.
[12]陈龙, 林志雄, 梅文忠, 等. 儿童后颅窝病变术后皮下积液的成因及防治[J]. 中华神经外科杂志,2009,25(12): 1103-1105.
CHEN L, LIN Z X, MEI W Z, et al. Causes prevention and management of subcutaneous hydrops after craniotomy of posterior cranial fossa in children[J]. Chin J Neurosurg, 2009,25(12):1103-1105.
[13]STEINBOK P, SINGHAL A, MILLS J, et al. Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis[J]. Childs Nerv Syst, 2007, 23(2): 171-174. DOI:10.1007/s0038100602340.
[14]林佳平, 单臻, 黄毓婵, 等. 儿童后颅窝肿瘤合并脑积水的治疗及预后影响因素分析[J]. 中华神经医学杂志, 2011, 10(5): 489-492. DOI:10.3760/cma.j.issn.16718925. 2011.05.015.
LIN J P, SHAN Z, HUANG Y C, et al. Treatment and prognosis of posterior fossa tumor combined with hydrocephalus in children: an analysis of influencing factors[J]. Chin J Neuromed, 2011, 10(5): 489-492. DOI:10.3760/cma.j.issn.16718925.2011.05.015.
[15]崔向丽, 林松, 隋大立, 等. 神经外科术后颅内感染的诊疗进展[J]. 中华神经外科杂志, 2014, 30(3): 312-314. DOI:10.3760/cma.j.issn.10012346.2014.03.030.
CUI X L, LIN S, SUI D L, et al. Diagnosis and treatment progress of postoperative intracranial infection in department of neurosurgery[J]. Chin J Neurosurg, 2014, 30(3): 312-314. DOI:10.3760/cma.j.issn.10012346.2014.03.030.
[16]YONG C I, HWANG S K, KIM S H. The role of lumbar drainage to prevent shuntdependent hydrocephalus after coil embolization for aneurysmal subarachnoid hemorrhage in goodgrade patients[J]. J Korean Neurosurg Soc, 2010, 48(6): 480-484. DOI:10.3340/jkns.2010.48.6.480.
[17]魏大伟, 刘家传, 王春琳, 等. 腰大池持续外引流对创伤性蛛网膜下腔出血患者脑CT灌注成像的影响[J]. 中华神经医学杂志, 2015, 14(2): 181-184. DOI:10.3760/cma.j.issn.16718925.2015.02.016.
WEI D W, LIU J C, WANG C L, et al. Effect of lumbar continuous drainage on cerebral computed tomography perfusion in patients with traumatic subarachnoid hemorrhage[J]. Chin J Neuromed, 2015, 14(2): 181-184. DOI:10.3760/cma.j.issn.16718925.2015.02.016.
[18]刘晓琴, 陈强, 孙斌, 等. 腰大池持续脑脊液引流术在重型颅脑损伤术后脑脊液漏中的应用[J]. 中华神经外科杂志, 2016, 32(6): 593-595. DOI:10.3760/cma.j.issn.10012346.2016.06.014.
LIU X Q, CHEN Q, SUN B, et al. Application of continuous lumbar cerebrospinal fluid drainage in cerebrospinal fluid leakage after severe craniocerebral injury[J]. Chin J Neurosurg, 2016, 32(6): 593-595. DOI:10.3760/cma.j.issn.10012346.2016.06.014.
[19]徐昊, 牛朝诗, 丁宛海, 等. 腰大池持续引流治疗脑脊液漏疗效的系统评价[J]. 中国循证医学杂志, 2014, 14(9): 1091-1096. DOI:10.7507/16722531.20140178.
XU H, NIU C S, DING W H, et al. Effectiveness of continuous lumbar drainage for CSF leakage: A systematic review[J]. Chin J EvidBased Med, 2014, 14(9): 1091-1096. DOI:10.7507/16722531.20140178.

更新日期/Last Update: 2018-03-10