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目的总结小儿结核性脑膜炎后脑积水(TBMH)行脑室腹膜分流术(VPS)的效果,分析其影响因素,探讨VPS的适应证和时机。方法总结我院经VPS治疗小儿TBMH病例56例,部分病例VPS手术前行脑室外引流(EVD)。结果手术后GOS分级,效果较好(恢复良好和中度致残)33例,占58.9%;效果较差(重度致残、植物生存和死亡)23例,占41.1%。手术后GOS与手术前GCS分级、TBM分级、手术前抗结核治疗时间等有关,而与患儿的年龄、手术前是否有癫痫发作、脑积水的类型和程度、手术前CSF细胞计数和蛋白含量等无关。发生非感染性堵管4例,分流管感染2例,腹部伤口感染1例,腹部CSF囊肿1例。结论VPS治疗TBMH可以取得较好的效果,手术前GCS和TBM分级是影响TBMH患儿行VPS治疗预后最重要的因素。
Objective To summarize the effect of intraventricular peritoneal shunt (VPS) on hydrocephalus after tuberculous meningitis in children and analyze the influencing factors and the indications and timing of VPS. Methods 56 cases of pediatric TBMH treated by VPS in our hospital were summarized. In some cases, ventricular external drainage (EVD) was performed before VPS. Results After operation, GOS was graded with good effect (good recovery and moderate disability) in 33 cases (58.9%), and poor response (severe disability, plant survival and death) in 23 cases (41.1%). The postoperative GOS was related to the preoperative GCS grade, TBM grade, preoperative antithrombotic treatment time and so on, but not with age, preoperative seizure, type and degree of hydrocephalus, preoperative CSF cell count and protein Content has nothing to do. Non-infectious occlusion occurred in 4 cases, shunt infection in 2 cases, 1 case of abdominal wound infection, abdomen CSF cyst in 1 case. Conclusion VPS treatment of TBMH can achieve better results. Preoperative GCS and TBM grading are the most important factors that affect the prognosis of children with TBMH undergoing VPS.