Ommaya储液囊植入治疗早产儿脑室内出血后脑积水的疗效及其影响因素分析

Therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage and factors associted with the therapeutic effect

摘要:

目的：观察Ommaya储液囊植入治疗早产儿脑室内出血后脑积水的临床疗效并探讨影响其疗效的相关因素。方法：采用双向性队列研究的方法分析20例因脑室内出血后脑积水而接受Ommaya储液囊植入术治疗的早产儿（胎龄＜32周，出生体重＜1500 g）的临床资料及随访资料，观察手术的治疗效果。根据治疗效果的不同分为治愈组和治疗失败组，采用单因素分析的方法探讨影响其疗效的相关因素。结果：(1)Ommaya储液囊植入术后 30 d，脑积水情况明显改善。(2)术后3个月，部分患儿临床疗效显著下降：术后3~6个月内7例转行脑室-腹腔分流术，4例因经济原因放弃治疗，1例因头皮下血肿伴皮肤坏死转行第三脑室底造瘘术；其余8例至12~18个月时脑室恢复正常大小。(3)并发症情况：术后继发性脑室内出血8例，颅内感染2例，头皮下血肿伴皮肤坏死1例。(4)单因素分析显示胎龄、出生体重、Ommaya储液囊植入时脑积水时间在治愈组和治疗失败组比较差异有统计学意义（P＜0.05）。结论：Ommaya储液囊植入术治疗早产儿颅内出血后脑积水短期内疗效显著，但随时间延长部分患儿治疗效果降低。小胎龄、低出生体重、脑积水时间长可能是影响疗效的主要因素。

Abstract:

OBJECTIVE: To observe the therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage (IVH) and to investigate factors influencing the therapeutic effect. METHODS: An ambispective cohort study was conducted on the clinical and follow-up data of 20 premature infants (gestational age <32 weeks, birth weight <1500 g) who received Ommaya reservoir implantation because of hydrocephalus following IVH. The therapeutic effect of Ommaya reservoir implantation was observed. These patients were divided into cure and treatment failure groups according to their treatment outcomes. The factors influencing therapeutic effects were investigated by univariate analysis. RESULTS: Hydrocephalus was relieved significantly at 30 days after Ommaya reservoir implantation. However, some patients showed significantly decreased therapeutic effects since 3 months after operation: during 3-6 months after operation, 7 cases underwent ventriculoperitoneal shunt, 4 cases discontinued treatment because of economic reasons, and 1 case underwent endoscopic third ventriculostomy due to scalp hematoma with skin necrosis. The ventricles of the remaining 8 cases returned to normal size at 12-18 months after operation. As for postoperative complications, secondary IVH was seen in 8 cases, intracranial infection in 2 cases, and scalp hematoma with skin necrosis in 1 case. The univariate analysis revealed significant differences in gestational age, birth weight and duration of hydrocephalus before Ommaya reservoir implantation between the cure and the treatment failure groups (P<0.05). CONCLUSIONS: Ommaya reservoir implantation has a remarkable short-term therapeutic effect on hydrocephalus in premature infants following IVH, but later the effect decreases in some patients. Low gestational age, low birth weight and long duration of hydrocephalus may be the main factors influencing therapeutic effects of Ommaya reservoir implantation.