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

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.

Application of early continuous lumbar cerebrospinal fluid drainage in children after resection of posterior cranial fossa tumors

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.