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目的探讨后颅窝肿瘤合并梗阻性脑积水行分流术后所致瘤内出血的诊断和治疗经验。方法回顾性分析上海儿童医学中心2013年1月至2014年6月收治后颅窝肿瘤合并脑积水患儿临床资料,均为行分流术而后发生瘤内出血病例。结果该院收治的后颅窝肿瘤合并脑积水患儿11例,其中2例患者出现术后瘤内出血。出血后短期内1例接受手术,1例予以保守治疗,后期病理分别为未成熟畸胎瘤(II级)和胶质神经元肿瘤(Ⅰ级)。结论后颅窝肿瘤常合并梗阻性脑积水,先行分流术后,发生瘤内出血较为罕见。分流术后病情突然恶化,需考虑瘤内出血可能,应急诊行头颅CT检查,并根据具体情况选择最佳治疗措施。
Objective To investigate the diagnosis and treatment of intratumoral hemorrhage caused by shunt of posterior fossa tumor with obstructive hydrocephalus. Methods The clinical data of children with cranial fossa with hydrocephalus from January 2013 to June 2014 in Shanghai Children’s Medical Center were retrospectively analyzed. All patients underwent shunting followed by intratumoral hemorrhage. Results The hospital admitted 11 cases of posterior fossa tumors with hydrocephalus in children, including 2 patients with postoperative intra-tumor hemorrhage. One patient underwent surgery after a short-term hemorrhage and one patient underwent conservative treatment. The pathology was immature teratoma (grade II) and glial neurone (grade I), respectively. Conclusions Posterior fossa tumors often complicated by obstructive hydrocephalus, after the first shunt, the occurrence of intratumoral hemorrhage is relatively rare. After the shunt suddenly deteriorated, need to consider the possibility of intratumoral hemorrhage, emergency line head CT examination, and according to the specific circumstances to choose the best treatment.