脑室-腹腔分流术治疗儿童结核性脑膜炎脑积水疗效研究［摘要］目的分析脑室-腹腔分流术(VPS)治疗儿童结核性脑膜炎脑积水(TBMH)的临床疗效。方法选取TBMH患儿45例，所有患儿均行VPS治疗。记录患儿年龄、手术前后GCS评分、TEM分级、脑积水的类型和程度、术前抗结核治疗时间、术后恢复情况和术后并发症情况。分析患儿术后的疗效，同时比较疗效好和疗效差患儿参数差异。结果治疗效果好27例(60%),效果较差18例(40%)；术后近期出现并发症7例，发生率为15.6%。与疗效差患儿相比，疗效好患儿术前GCS评分较高、抗结核治疗时间较长、TBM分级较低，差异有统计学意义(PC0.05)。结论VPS是一种有效治疗儿童TBMH的方法，其疗效可能与术前GCS评分、抗结核治疗时间、TBM分级有关。［关键词］脑室-腹腔分流术；结核性；脑膜炎；脑积水；儿童［］R529.3［文献标识码］A［］1674-4721(2012)07(c)-0051-02Analysisofcurativeeffectonventriculo-peritonealshuntinthetreatmentofchildhoodtuberculousmeningitishydrocephalusFENGShubinLUShanQILinDepartmentofNeurosurgery,ZhengzhouChildren"sHospitalinHe，nanProvince,Zhengzhou450053,China[Abstract]ObjectiveToanalyzetheclinicaleffectofventriculo-peritonealshunt(VPS)inthetreatmentofchildhoodtuberculousmeningitishydrocephalus(TBMH)・MethodsFortyfivecasesofchildrenwithTBMHwerechosen.AllthechildrenweregiventhetreatmentofVPS・Thechildren"sage,GCSscoresbeforeandaftertheoperation,TBMclassifications,thetypesandlevelsofhydrocephalus,thepreoperativetreatmenttimeofanti-tuberculosis,therecoveryconditionsafteroperationandthecomplicationsafteroperationwererecorded・Thepostoperativeeffectsofchildrenwereemalyzed,atthesametime,theparametriedifferencesamongbettereffectsandworseeffectsinchildrenwerecompared・ResultsTherewere27cases(60%)ofgoodcurativeeffectsand18cases(40%)ofworseeffects；thepostoperativeshort-termcomplicationsoccurredin7cases,withtheincidenceof15.6%.Comparedwiththechildrenwithworseeffects,thepreoperativeGCSscoresofchildrenwithbettereffectswerehigher,thetreatmenttimeofanti-tuberculosiswaslonger,TBMclassificationswerelower,thedifferenceswerestatisticallysignificant(P<0.05).ConclusionVPSisaneffectivewayinthetreatmentofchildhoodTBMH,itseffectsmaybeconnectedwithpreoperativeGCSscores,thetreatmenttimeofanti~tuberculosisandTBMclassifications・［Keywords］Ventriculo-peritonealshunt；Tuberculous；Meningitis；Hydrocephalus；Children脑积水是指由于脑脊液循环通路阻塞使脑脊液在颅内大量积聚，而导致脑室进行性扩大的一种疾病，根据阻塞原因分为梗阻性脑积水和交通性脑积水。结核性脑膜炎脑积水(tuberculousmeningitishydrocephalus,TBMH)是小儿结核性脑膜炎常见的并发症，发生率可达48%,多为梗阻性脑积水［1］。解除梗阻原因是TBMH最理想的治疗方法，但成功率不高，如何有效治疗TBMH一直是儿科临床医生十分头疼的问题。目前，脑室-腹腔分流术(ventriculoperitonealshunting,VPS)是儿童脑积水的最常用治疗方法之一，其可以解除脑脊液循环障碍，使脑脊液的分泌与吸收得到平衡，降低颅内高压，达到治疗脑积水的目的［2］，但应用VPS治疗儿童TBMH的时机和疗效仍存在争议。本研究通过分析VPS治疗45例儿童TBMH的临床资料，来探讨VPS治疗儿童TBMH的疗效。