颅咽管瘤显微手术中垂体柄辨认和保留的研究

目的 探讨颅咽管瘤术中垂体柄辨认和保留的重要性.方法回顾显微外科手术治疗颅咽管瘤69例的临床资料,对肿瘤的临床表现、内分泌学和影像学特点、肿瘤切除程度、术中垂体柄的辨认和保留情况、术后随访进行系统分析.结果 肿瘤全切除50例(72.5%),次全切除13例(18.8%),部分切除6例(8.7%);术中能发现和辨认出垂体柄57例(82.6%),垂体柄完整保留41例(59.4%),部分保留9例(13.0%),垂体柄保留率为72.5%.结论 结合术前影像、肿瘤分型、垂体柄的特征,颅咽管瘤术中垂体柄能够辨认和得到保留,对术后远期生活质量提高具有重要意义.     

可调压与非可调压分流管治疗儿童交通性脑积水疗效的比较

目的 探讨可调压与非可调压分流管治疗儿童交通性脑积水的效果.方法 中山大学附属第一医院神经外科自2003年1月至2009年12月行侧脑室腹腔分流术(VPS)治疗交通性脑积水儿童患者66例,其中采用Codman Hakim可调压分流管27例,采用Medtronic非可调压分流管39例,比较可调压分流管组和非可调压分流管组患者的并发症和分流装置平均生存时间.结果 2组患者分流管相关性感染、脑室端和腹腔端堵塞、硬膜下积液或血肿的发生率比较差异均无统计学意义(P＞0.05).可调压分流管组分流装置平均生存时间为52.55个月,非可调压分流管组分流装置平均生存时间为42.33个月,2组分流装置生存曲线相比较差异无统计学意义(x2=0.763,P=0.382).结论 与非可调压分流管相比,未发现使用可调压分流管治疗儿童交通性脑积水有明显的优势.

Abstract：

Objective To analyze the outcomes of adjustable and set-pressure valves in the management of communicating hydrocephalus in children. Methods A retrospective study reviewing the medical records of 66 children with communicating hydrocephalus who received ventriculoperitoneal shunt at our center from January 2003 to December 2009 was performed. All the patients were divided into 2 groups: Codman Hakim adjustable valve group (n=27) and Medtronic set-pressure valve group (n=39). Rate of appearing complication and shunt survival time were analyzed between the 2 groups.Results The rate of shunt infection, proximal or distal obstruction, subdural hematoma and subdural hygroma showed no statistical significance between patients of the adjustable and set-pressure valve groups (P=1.000, P=0.727, P=0.455, P=0.691, respectively). The average shunt survival time of children in the adjustable valve group was 52.551 months (38.169-66.852, 95% CI) and that of children in the set-pressure valve group was 42.327 (31.636-53.019, 95%CI); no statistical significance on the average shunt survival time between these 2 groups was noted (x2=0.763, P=0.382).Conclusion The adjustable valve is not superior to set-pressure valve in the treatment of communicating hydrocephalus in children.