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目的探讨婴幼儿先天性梗阻性脑积水经神经内镜三脑室底造瘘术(ETV)治疗疗效。方法 2011年7月至2014年1月,将33例经ETV治疗的先天性梗阻性脑积水患儿根据手术年龄段分为ETV≤6月组(n=17)与ETV>6月组(n=16),随访术后6个月并进行神经发育评测(采用Gesell儿童智力发育诊断量表,包括大运动行为、精细运动行为,适应能力、语言功能及个人一社会行为)。比较两组患儿手术疗效与术后神经发育状态。结果 ETV≤6月组与ETV>6月组术后神经发育预后具有统计学差异(P﹤0.05),ETV≤6月组患儿在大运动行为,精细运动行为,适应能力,语言功能及个人-社会行为方面均不如于ETV>6组患儿(23.00±3.62vs.48.81±6.81;25.94±3.07 vs.55.56±8.40;15.00±3.06 vs.40.94±6.69;20.00±3.06 vs.45.81±6.81;21.12±3.22 vs.45.88±7.22);ETV≤6组患儿中,重度神经发育障碍17例(100%)(DQ值﹤40),而ETV>6月组患儿中重度神经发育障碍1例(6.25%)。结论出生6个月以内行神经内镜下三脑室底造瘘术(ETV)治疗婴幼儿先天性梗阻性脑积水手术成功率低,术后神经发育预后欠佳。
Objective To investigate the efficacy of congenital obstructive hydrocephalus treated with endoscopic three-ventrostomy (ETV) in infants and young children. Methods From July 2011 to January 2014, 33 children with congenital obstructive hydrocephalus treated with ETV were divided into ETV≤6 months (n = 17) and ETV> n = 16). Neuropsychological evaluation was performed 6 months postoperatively (using the Gesell Childhood Diagnostic Scale for Mental Development, including large motor behaviors, fine motor behaviors, fitness, language function, and individual-social behavior). The surgical outcomes and postoperative neurodevelopmental status were compared between the two groups. Results ETV≤6 months group and ETV> June group postoperative neurological development prognosis was statistically significant (P <0.05), ETV≤6 month group of children in large sports, fine motor behavior, adaptability, language function and individual - Social behavior was not as good as in ETV> 6 groups (23.00 ± 3.62 vs.48.81 ± 6.81; 25.94 ± 3.07 vs.55.56 ± 8.40; 15.00 ± 3.06 vs.40.94 ± 6.69; 20.00 ± 3.06 vs.45.81 ± 6.81; 21.12 ± 3.22vs.45.88 ± 7.22); 17 cases (100%) of severe neurodevelopmental disorder in ETV≤6 group (DQ value <40), while 1 case of severe neurodevelopmental disorder in ETV> 6 monthgroup (6.25%). Conclusion The success rate of operation of congenital obstructive hydrocephalus in infants and young children undergoing endoprosthetic endoscopic three-ventrostomy (ETV) within 6 months after birth is poor. The prognosis of postoperative neurological development is poor.