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目的探讨脑室帽状腱膜下引流术治疗早产儿脑室内出血后脑积水的手术方法、安全性、并发症及临床转归。方法收集我院2012年2月至2015年1月脑室内出血后脑积水并予脑室帽状腱膜下引流术的早产儿资料,分析治疗过程的安全性、治疗期间并发症的处理及治疗效果。结果共入选12例患儿,均在床边行脑室帽状腱膜下引流术。患儿手术后均未出现颅内感染、出血、头皮感染。伤口愈合不良1例,囊肿穿刺部位渗液1例,引流管移位2例,手术后因呼吸暂停予呼吸机辅助通气24 h后撤机1例。5例患儿单纯通过帽状腱膜下引流即保持脑室稳定且逐步缩小,在术后1年拔除了引流管;2例患儿在术后10周行脑室腹腔分流术并去除帽状腱膜下引流管;4例患儿在帽状腱膜下引流术后10~12天开始行帽状腱膜下囊肿穿刺抽液,其中1例最终脑积水稳定,2例分别在10周和24周行脑室腹腔分流术,1例仍暂以囊肿穿刺抽液维持治疗中;1例患儿因合并其他疾病家长放弃治疗。结论脑室帽状腱膜下引流术可床边操作,结合必要时的穿刺抽液,是治疗早产儿脑室内出血后脑积水简单、安全而有效的方法。
Objective To investigate the surgical methods, safety, complications and clinical outcomes of ventricular subgaleal subdural drainage in the treatment of hydrocephalus after intraventricular hemorrhage in premature infants. Methods The data of premature infants with intracerebral hemorrhage after intraventricular hemorrhage from February 2012 to January 2015 in our hospital were collected to analyze the safety of the treatment course, the treatment and treatment of complications during the treatment. Results A total of 12 children were enrolled in the study. Children had no intracranial infection after surgery, bleeding, scalp infection. 1 case of poor wound healing, 1 case of exudate in the puncture site of the cyst, 2 cases of drainage tube displacement, and 1 case of weaning due to apnea-ventilator-assisted ventilation for 24 h after operation. 5 cases of children simply through the subgaleal drainage cap to keep the ventricle stable and gradually reduced, 1 year after the removal of the drainage tube; 2 cases of children in 10 weeks after the operation of peritoneal shunt and removal of the capsular aponeurosis And 4 cases underwent subgaleal subdural cyst puncture aspiration in 10 to 12 days after subdural drainage. One case had stable final hydrocephalus with two cases at 10 and 24 weeks respectively Peripheral ventricle peritoneal shunt, 1 case was still cyst puncture fluid maintenance treatment; 1 case of children with other diseases due to merger to give up treatment. Conclusions Subdural drainage of the subchondral capsulotomy can be operated at the bedside and combined with puncture fluid extraction when necessary. It is a simple, safe and effective method for the treatment of hydrocephalus after intraventricular hemorrhage in preterm infants.