儿童后颅窝病变术后皮下积液的成因及防治

目的 探索儿童后颅窝病变术后皮下积液的原因及防治措施.方法 回顾性分析34例儿童后颅窝病变行手术切除患者的临床资料.结果 34例中有8例发生术后皮下积液,其中术中未严密缝合硬脑膜(6/12)及合并术后脑积水者(4/6)显著高于严密缝合硬脑膜(2/22)与未发生脑积水者(4/28)(P＜0.05);术中未行骨瓣复位者(4/11)有高于骨瓣复位者(4/23)的趋势,但差异无统计学意义(P＞0.05).是否放置术腔外引流与皮下积液的发生无明显关系(P＞0.05).结论 儿童后颅窝病变术后皮下积液的形成与术中未严密缝合硬脑膜及术后并发脑积水关系密切,其防治有赖于针对上述环节的妥善处理.

Causes prevention and management of subcutaneous hydrops after craniotomy of posterior cranial fossa in children

Objective To analyze the causes of subcutaneous hydrops following operation on lesions in posterior cranial fossa and discuss how to prevent and cure it.Methods The clinical data of 34 children who underwent neurosurgical operation for posterior cranial fossa lesions between July 2003 and December 2008 were analyzed retrospectively.Results Out of 34 posterior cranial fossa operations, 8 subcutaneous hydrops were identified.Higher rates of subcutaneous hydrops were associated with incomplete dural closure (6/12 vs 2/22) and the development of postoperative hydrocephalus (4/6 vs 4/28). The differences were statistically significant( P＜0.05). There was also a trend towards higher occurrence in cases with skull defect (4/11 vs 4/23), although it didn't reach statistical significance(P＞0.05). The use of subdural drainage seemed to be not associated with subcutaneous hydrops (P＞0.05). Conclusion Incomplete dural closure and postoperative hydrocephalus are main reasons of subcutaneous hydrops following operation on lesions in posterior cranial fossa in children, which can be prevented by a watertight dural closure and treatment of postoperative hydrocephalus effectively.