脑室腹腔分流术后分流管阻塞的诊断和处理  

The diagnosis and treatment of ventriculoperitoneal shunt blockage

作　　者：邸方 王胜[1] 李龄[1] 舒凯[1] 

机构地区：[1]华中科技大学同济医学院同济医院神经外科,430030 [2]武汉市东西湖区人民医院外科

出　　处：《中华小儿外科杂志》2011年第6期414-416,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨脑积水脑室腹腔分流术后分流管阻塞的诊断和处理。方法收集1977年-2007年由同济医院神经外科治疗的脑积水127例（儿童29例，婴幼儿98例），其中40例出现分流功能障碍行矫正手术。研究发现脑脊液分流障碍的早期表现是脑脊液分流隧道聚积，少数病例有分流感染，分流导管堵塞来自脉络丛，其他常见异物（棉花纤维、毛发、炎性肉芽组织等）围绕脑室与腹腔导管的末端。防止分流管阻塞的措施包括：①选择最佳脑室导管；②预防感染；③手术薄膜覆盖皮肤，避免与分流导管接触；④改善移植材料的生物相容性。结果随访5～10年，除2例髓母细胞瘤并发脑积水死亡外，其余38例长期存活。结论脑室腹腔分流术后功能障碍应及时矫正处理。Objective To explore the diagnosis and treatment of ventriculoperitoneal shunt blockage. Methods Retrospective study was conducted in 127 patients with hydrocephalus （29 children and 98 infants） referred to Department of Neurosurgery between 1977 and 2007, 40 of them received surgery for shunt malfunction. Referral pattern, presenting symptoms and signs, results of computed tomography （CT） scanning, operative findings, and clinical outcomes were recorded. Results The early manifestations of shunt dysfunction included： accumulation of cerebrospinal fluid diversion tunnels, shunt infections, shunt catheter blockage from the choroid plexus, and foreign body （cotton fiber, hair, inflammatory granulation tissue, etc. ）. The measures for preventing the shunt blockage included： optimal ventricle catheter, prevention of infection, avoiding contact with the shunt catheter by surgical film, and improving the graft material biocompatibility. During a follow-up period of 5-10 years, two cases with medulloblastoma cell tumor died, the other cases achieved long-term survival. Conclusions The shunt dysfunction should be managed properlv to get excellent lone-term results.

关 键 词：脑积水 脑室腹腔分流术 

分 类 号：R651.1[医药卫生—外科学]