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目的探讨不同年龄段儿童先天性梗阻性脑积水行神经内镜下三脑室底造瘘术(ETV)治疗疗效及术后神经发育预后。方法选择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个月组(n=17)与ETV>6个月组(n=16),术后随访6个月,并采用“Gesell儿童智力发育诊断量表”进行神经发育评测,包括大运动行为、精细运动行为、适应能力、语言功能及个人-社会行为。比较两组患儿手术成功率与术后神经发育状态。结果 ETV≤6个月组与ETV>6个月组术后神经发育预后具有统计学差异(P<0.05),ETV≤6个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ETV>6个月组患儿;ETV≤6个月组患儿中,重度神经发育障碍17例(100%)(DQ值<40),手术成功率为35.3%,而ETV>6个月组患儿中重度神经发育障碍1例(6.25%),手术成功率为62.5%。结论出生6个月以内儿童先天性梗阻性脑积水行神经内镜下三脑室底造瘘术(ETV)治疗手术成功率低,术后神经发育预后欠佳。
Objective To investigate the efficacy of neuroendoscopic endoscopic three-ventrostomy (ETV) in children with congenital obstructive hydrocephalus at different ages and the prognosis of postoperative neurodevelopment. Methods Thirty-three ETV-treated children with congenital obstructive hydrocephalus were divided into ETV group (n = 17) and ETV group (n = 16) All patients were followed up for 6 months. The neurological assessment was performed using the “Gesell Diagnostic Scale for Mental Development of Children”, which included major motor activities, fine motor behaviors, adaptability, language function and personal-social behavior. The success rate of surgery and postoperative neurodevelopmental status were compared between the two groups. Results There was a significant difference in postoperative neuropsychological prognosis between ETV≤6 months group and ETV> 6 months group (P <0.05). ETV≤6 months group had significant difference in major sports behavior, fine motor behavior, adaptability, language Function and personal - social behavior are not as good as ETV> 6 months children; ETV≤6 months in children with severe neurodevelopmental disorders in 17 cases (100%) (DQ value <40), the surgical success rate was 35.3 %, While ETV> 6 months in children with severe neurodevelopmental disorders in 1 case (6.25%), the surgical success rate was 62.5%. Conclusion The success rate of endoscopic three-ventrostomy (ETV) in children with congenital obstructive hydrocephalus within 6 months after birth is low, and the prognosis of postoperative neurological development is poor.