Long-term outcome of hydrocephalus management in myelomeningoceles
Long-term outcome of hydrocephalus management in myelomeningoceles
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脊髓脊膜膨出脑积水治疗的长期结果
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
M. Lamberti
中科院分区：
文献类型：
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作者：
S. Tuli;J. Drake;M. Lamberti
脑脊液(CSF)分流仍然是脊髓脊膜膨出(MMC)患者持续存在的重要管理问题。我们回顾了来自单一机构的前瞻性随访的MMC患者组的长期分流治疗结果。方法选择1987-1996年诊断为MMC的前瞻性脑积水患者。所有数据都从医疗记录中得到核实，并收集了有关分流手术的更多细节。分流失败的结果被分类为分流阻塞、分流感染、存在有房室的脑室、过度引流等。所有的死亡都被记录下来，并确定了原因。分流失败危险因素的单因素分析采用对数等级统计法。结果189MMC患者中发生首次分流失败120例(%)，中位时间303天，分流失败29例(24%)，手术感染率为15%。61名患者经历了第二次分流失败，38名患者经历了第三次分流失败，36名患者经历了四次或更多分流失败。风险因素的多变量分析未能证明首次或随后分流失败的任何明确的风险因素。15例死亡，其中13例死于分流术或Chiari-1并发症。结论分流术并发症仍是MMC患者发病率和死亡率的重要原因，尤其是分流术感染。
BackgroundThe cerebrospinal fluid (CSF) shunt remains an important ongoing management problem in myelomeningocele (MMC) patients. We reviewed the long-term shunt treatment outcome in a prospectively followed group of MMC patients from a single institution.MethodPatients prospectively entered into a hydrocephalus database with a diagnosis of MMC from the years 1987 to 1996 were selected. All data was verified from the medical records and additional details about the shunt surgery were collected. The outcome of shunt failure was categorized as shunt obstruction, shunt infection, presence of loculated ventricles, overdrainage, and other. All deaths were recorded and causation identified. Univariate analysis for shunt failure risk factors was accomplished using Log rank statistics. Multivariable analysis was performed for each repeated failure level using a conditional Cox regression model.ResultsOne hundred and twenty (64%) out of 189 MMC patients experienced a first shunt failure with a median time of 303 days; 29 (24%) of the failures were due to shunt infection (the procedure infection rate being 15%). Sixty-one patients experienced a second shunt failure, 38 a third and 36 had four or more. Multivariable analysis of risk factors failed to demonstrate any clear risk factors for either first or subsequent shunt failure. Fifteen patients died, 13 from either shunt or Chiari 1 complications.ConclusionShunt complications remain an important cause of morbidity and mortality in MMC patients, particularly shunt infection.