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[大学生论坛]:乌干达儿童脑积水治疗:内镜治疗VS分流术

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fee. 发表于 2017-12-31 12:38:36 | 显示全部楼层 |阅读模式
本帖最后由 fee. 于 2017-12-31 12:42 编辑

Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda
乌干达儿童脑积水治疗:内镜治疗VS分流术


BACKGROUND背景
Postinfectious hydrocephalus in infants is a major health problem in sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, but surgeons are usually not immediately available to revise shunts when they fail. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV–CPC) is an alternative treatment that is less subject to late failure but is also less likely than shunting to result in a reduction in ventricular size that might facilitate better brain growth and cognitive outcomes.
在撒哈拉以南非洲,婴儿感染后脑积水是一个重要的健康问题。传统的治疗方法是进行脑室腹腔分流术(VPS),但当治疗出现故障时,当地缺少可以立即实施修复术的外科医生。内镜下第三脑室造口术联合脉络丛烧灼术 (ETV–CPC)是一种迟发性失败较少的替代疗法,但脑室体积减小的效果不如VPS明显。


METHODS方法
We conducted a randomized trial to evaluate cognitive outcomes after ETV–CPC versus ventriculoperitoneal shunting in Ugandan infants with postinfectious hydrocephalus.
研究人员进行了一项随机试验来比较患感染后脑积水的乌干达婴儿在接受ETV–CPC或VPS治疗后的认知发育。

The primary outcome was the Bayley Scales of Infant Development, Third Edition (BSID-3), cognitive scaled score 12 months after surgery (scores range from 1 to 19, with higher scores indicating better performance). The secondary outcomes were BSID-3 motor and language scores, treatment failure (defined as treatment-related death or the need for repeat surgery), and brain volume measured on computed tomography.
主要结果为婴儿发育贝利量表第三版(BSID-3),术后12个月时的量表认知评分(分数从1到19,分数越高显示表现越好)。次要结果为BSID-3运动和语言评分,治疗失败(定义为治疗相关死亡或需要修复手术),以及CT脑体积测量。


RESULTS结果
A total of 100 infants were enrolled; 51 were randomly assigned to undergo ETV–CPC, and 49 were assigned to undergo ventriculoperitoneal shunting.
该项研究共纳入100名患儿,51名婴儿被随机分配接受ETV—CPC,49名婴儿接受VPS。


The median BSID-3 cognitive scores at 12 months did not differ significantly between the treatment groups (a score of 4 for ETV–CPC and 2 for ventriculoperitoneal shunting; Hodges–Lehmann estimated difference, 0; 95% confidence interval [CI], −2 to 0; P=0.35).
术后12个月时,两组BSID-3认知评分的中位数差异不显著(ETV–CPC组4分,VPS组2分,霍奇莱曼差异为0;可信区间[CI]95%;−2 to 0; P=0.35)

There was no significant difference between the ETV–CPC group and the ventriculoperitoneal-shunt group in BSID-3 motor or language scores, rates of treatment failure (35% and 24%, respectively; hazard ratio, 0.7; 95% CI, 0.3 to 1.5; P=0.24), or brain volume (z score, −2.4 and −2.1, respectively; estimated difference, 0.3; 95% CI, −0.3 to 1.0; P=0.12).
在BSID-3运动和语言评分,治疗失败率(分别为35%和24%;危险比0.7;95%CI,0.3至1.5;P=0.24)以及脑体积(Z评分,分别为−2.4和−2.1,估差,0.3;95% CI,−0.3到1;P = 0.12)方面,两组间并无显著差异。


CONCLUSIONS结论
This single-center study involving Ugandan infants with postinfectious hydrocephalus showed no significant difference between endoscopic ETV–CPC and ventriculoperitoneal shunting with regard to cognitive outcomes at 12 months. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01936272.)
研究认为,在发生感染后脑积水的乌干达婴儿中,脑室腹腔分流术或内镜下第三脑室造口术联合脉络丛烧灼术的认知结局无差异。



Source:
N Engl J Med 2017; 377:2456-2464December 21, 2017DOI: 10.1056/NEJMoa1707568




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