新生儿脊膜脊髓膨出合并脑积水的外科治疗(附6例报告)

目的 探讨新生儿期脊膜脊髓膨出合并脑积水的发病机理和手术时机。方法 头颅CT6例。腰骶部CT2例，腰骶部X线照片6例。1例分二期行脑室腹腔分流和脊膜脊髓膨出修复术，5例一期手术，分流术中测量颅内压。结果 4例颅内压正常，2例颅内高压，1例分二期手术在行脑室腹腔分流术后脊膜脊髓膨出体积明显缩小。6例伤口愈合良好，随访半年至3年无复发，CT未见脑积水，临床症状好转。结论 脑积水可促进腰骶部脊膜脊髓膨出，在新生儿期行脑室腹腔分流和膨出修补手术疗效良好。显微手术能防止术后脊髓栓系发生。

Surgical Treatment for Myelomeningocele Associated With Hydrocephalus in Neonate(6 Case Report and Review of the Literature)

Objective To determine pathogenesis and the suitable time of operation for myelomeningocele associated with hydrocephalus in neonate.Methods 6 underwent head CT scanning, 2 lumbosacral CT scanning and 6 lumbosacral X radiography on 6 patients myelomeningocele complicated with hydrocephalus.Ventriculoperitoneal shunt and repair of the myelomeningocele were performed respectively for one patient.from 1 day to 28 day old.Operation stage 1 in 5 patients.Repair of the myelomeningocele concurred with ventriculoperitoneal shunt. Intracranial pressure was measured in shunting procedure.Results 4 patients had normal intracranial pressure,2 patients increased intracranial pressure in the 6 patients.The volume of the hernial sac had markedly diminished and status of hernial sac had greatly improved wall in the patient who wnderwent two-stage procedures after shunt procedure. Lumbosacral wound healing was good . No recurrent myelomeningocele was found, no hydrocephalus was seen using head CT scanning and clinical manifestation has improved in these patients who were followed up 6 month to 3 year.Conclusions Hydrocephalus may deteriorate the degree of lumbosacral myelomeningocele. Effecacy of vntriculoperitoneal shunt and repair of the myelomeningocele was excellent in myelomeningocele complicated with hydrocephalus in neonate.Micro-operative technique might prevent the occurrence of tethered cord.