个体化理念在脑室腹腔分流手术中的应用  

Individualized ideas in the application of the rentricle peritoneal shunt

作　　者：凌士营[1] 蒋辰[1] 牛朝诗[1] Ling Shiying Jiang Chen Niu Chaoshi.(Department of Neurosurgery , Anhui Provincia Hospital A f filieted To Anhui Medical University, Hefei, 230001, China)

机构地区：[1]安徽省立医院神经外科,安徽省脑立体定向神经外科研究所,合肥230001

出　　处：《立体定向和功能性神经外科杂志》2016年第5期297-301,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的评价在脑积水患者中采用个性化的枕角穿刺脑室一腹腔分流技术操作，对于提高分流管放置的准确性，降低分流管阻塞率的影响。方法2014年12月至2016年3月期间，对19例脑积水患者采用个体化脑室腹腔分流手术。选择右枕部枕外隆凸上6cm、中线旁开3cm处为颅骨钻孔点。切开头皮确认钻孔点位于同侧人字缝外侧缘，防止头皮滑动造成偏差。脑室穿刺方向为眉问上方1.5～2．0厘米正中矢状线上。脑室段置管长度以CT中自穿刺点皮层至同侧Monro孔前方，距脑室壁5毫米处的距离。采用腹腔穿刺针或者分层切开腹壁方法放置腹腔段分流管。测量初始颅内压，合理设定分流泵初始压力。在术后头颅CT三维重建影像上测量分析人字缝和钻孔点的空间关系、分流管脑室端的长度、脑室颅径比的改善等数据，验证个性化手术操作的合理性和准确性。结果本组19例脑室腹腔分流手术，均一次性置管成功（包括脑室段、腹腔段）。术后颅高压症状均立即减轻或者消失，意识状态明显改善。术后颅脑CT显示脑室段分流管位置理想，颅骨钻孔点距中线平均2．9cm，至枕外隆凸平面平均5．93cm。分流管脑室段的长度平均9．78cm。术前脑室颅径比为平均0．30，术后平均0．25。术后1～15个月随访，无分流管阻塞、中枢神经系统感染和穿刺道出血，无死亡。结论个性化分流技术是指准确确定枕部穿刺点、穿刺方向、脑室段长度和腹腔段长度等。该操作规范，手术时间短，分流管放置位置准确，减少脑组织穿刺损伤、腹腔内脏损伤等优点，有效地提高了穿刺成功率、降低了手术并发症，减少了术后分流管阻塞率。具有显著的临床指导价值。Objective To evaluate the effects of individualized ventriculoperitoneal shunt per- formed for patients with hydrocephalus to improve the accuracy of the shunt and reduce ventriculoperito- neal shunts obstruction. Methods From December 20]3, to March 2016,19 patients with hydrocephalus were performed individualized ventrieleperitoneal shunting. Skull drilling point was located at the right occipital, 6 cm above the external occipital protuberance, 3 cm away from the midline. Drilling point loca- ted away from the lateral edge of ipsilateral lambdoidal is confirmed after scalp was cut through to pre- vent dispalcement caused by scalp sliding. Ventricle puncture point is in the middle of the sagittal line 1.5 -2.0 cm above line between the intercilium. The length of the ventricular catheter is 5 mm from the ventricle wall,from the cortex of the puncture to ipsilateral Monro hole. Abdominal cavity puncture nee- dle or cut abdominal wall for placement the abdominal segment of shunt were used. Measured initial in- tracranial pressure and set adequate initial pressure of bypassing pump. The rationality and accuracy of in- dividualized operation on ventriculoperitoneal shunt were verified by diagnosing lambdoidal suture. Drill- ing point and the length of ventricle section of the shunt on postoperative cranial CT scan imaging. Results This group of 19 cases were performed ventricleperitoneal shunt all at once. Postoperative high cranial pressure symptoms reduced or disappeared immediately; and patients consciousness was improved imme- diately. Postoperative CT imaging showed skull drilling points were 2. 9 cm away from the midline and 5. 93 cm away from the plane of external occipital protuberance on average. The length of ventricle section of the shunt was 9.78 cm on average. Based on one to 15 months revisits,there was not any shunt tube ohstruction,centraI nervous system infection , puncture bleeding or death. Conclusion Individualized shunt technology is a method of accurately determining the puncturing point, punc

关 键 词：脑积水 V—P分流 个体化治疗 人字缝 

分 类 号：R651.15[医药卫生—外科学]