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兒童水腦症患者之預後及學習能力:初步報告

The Prognosis and Academic Performance in Children with Hydrocephalus: A Preliminary Report

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摘要


本研究探討不同成因之兒童水腦症患者的預後情形及學習表現。研究對象包括了自民國七十二年至八十六年經本院小兒神經外科診斷為水腦症,並於小兒神經外科及復健科門診持續追蹤者。病患依水腦成因的不同分為六大組,分別為:一、早產性水腦,二、不明原因性水腦,三、腦膜炎引發之水腦,四、先天腦室畸形之水腦, 五、脊髓膨出症合併之水腦,六、水腦但未接受手術者。分別比較各組第一次行分流術的年齡、再度手術的次數、手術失敗的原因、併發症的發生率、智力測驗結果及學校成績表現。結果顯示六十七位病患在平均追蹤5.48 ± 3.49年後,以脊髓膨出症合併水腦症患者行第一次行分流術的年齡最低;而腦膜炎所致的水腦症患者接受再度引流手術的平均機率,明顯的較其他組別為高,且此組病患的全智商比其他各組略低。在所有的患者中,有64.1%的病童可以進入一般學校就讀,而其中高達32%的患者成績居於全班同學的前三分之一。有20%的病童需接受特殊教育,7.7%因嚴重之身心障礙,無法接受任何形式之正規教育。本研究探討患者的生理預後情形,並針對水腦症手術之適應症,做文獻之整理與回顧。以便更了解病患的智商及學習表現,而為國內兒童水腦症患者預後情形之重要基本資料。

並列摘要


This study is to determine the prognosis and academic performance in hydrocephalic children with different etiologies. We reviewed the medical records of all the patients who had the diagnoses of hydrocephalus and had been regularly followed between 1983 and 1997. The patients were categorized into six different etiological groups as 1. premature type hydrocephalus, 2. idiopathic hydrocephalus, 3. hydrocephalus occurring after meningitis, 4. hydrocephalus associated with congenital anomalies, 5. hydrocephalus associated with myelomeningocele and 6. hydrocephalus not receiving any surgery. The ages at first shunt insertions, shunt revision rates, causes of shunt revisions, percentage of physical and mental handicap and intelligence test results were discussed. After a mean of 5.48 years of follow up in 67 patients, the group of hydrocephalus associated with myelomeningocele had the lowest first shunting age; hydrocephalus occurring after meningitis had significantly the highest revision rate and the lowest intelligence test scores. Sixty-four percent of those who answered the questionnaires went to normal schools and among them, 32% had excellent scores. Twenty percent of these patients required special forms of education and 7.7% could not receive any forms of education due to severe disabilities. This report reviewed the criteria of surgical interventions and discussed the outcome of different types of hydrocephalic patients, which is highly valuable in family counseling.

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