脑室-腹腔分流术中分流管腹腔端无需特殊处理  

No special management for peritoneal catheter in ventriculo -peritoneal shunt is required

作　　者：梁玉敏[1] 高国一[1] 包映晖[1] 丁圣豪[1] 潘耀华[1] 吴海波[1] 陈磊[1] 江基尧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中华神经外科杂志》2011年第4期431-434,共4页Chinese Journal of Neurosurgery

摘　　要：目的 前瞻性探讨脑室-腹腔（V-P）分流术后分流管腹腔端位置的动态变化,确定腹腔端的简单、有效处置方法.方法 回顾性总结采用V-P分流术治疗的40例脑积水患者,脑室端均采用额角穿刺,腹腔端采用剑突下4 cm正中切口,腹膜切开3 mm后将分流管腹腔端置入腹腔内.术后第1、3和7天常规复查头颅CT,同时行腹部平片确定腹腔端分流管位置.结果 CT显示40例均分流效果良好.腹部平片显示术后第1天分流管腹腔端位于盆腔31例,下腹腔5例;术后第3天和第7天分流管腹腔端位于盆腔内分别为35和39例.1例术后第5天发生对侧急性硬脑膜下血肿,家属放弃手术自动出院;余患者平均于术后（11±4）d出院.1例术后1年发生腹腔端感染,控制感染后改行脑室-心房（V-A）分流术;余患者术后随访1个月-2年,无相关并发症发生.结论 采用剑突下正中小切口,可减少手术创伤并缩短手术时间,获得良好的分流效果;分流管腹腔端处置的方法简单、实用,分流管腹腔端绝大多数在术后1 d内降入盆腔内,无需特殊固定和处理.Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt （V- P shunt） prospectively, and to determine simple, effective disposal method of peritoneal catheter. Method From Jan 2007 to Oct 2010, consecutive 40 patients with hydrocephalus were treated by V - P shunt. All patients were operated through puncture of frontal horn of lateral ventricle. And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well, the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum. Head CT scans were regularly made at the 1st, 3rd and 7th day after shunt to determine the intracranial state for all patients, and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time. All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases. And abdominal X-ray plain films at the 1st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases. At the 3rd day and 7th day after operation, the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively. Among these patients, a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation. This patient was discharged with GCS 6 as his family refused decompressive craniectomy. The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt. On follow - up, 1patient developed peritoneal infection one year later. After the infection was controlled, he was changed to ventriculo -atrial （V -A） shunt. There was no shunt -related complication occurred on the others during 1 -24 month follow - up periods. Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury, shorten the operating time and obtain good Results. Dynamic obse

关 键 词：脑积水 V—P分流术 腹部平片 

分 类 号：R651.1[医药卫生—外科学]