“阶梯式降压”及腹腔镜辅助脑室-腹腔分流治疗脑积水  

“Step by step down intracranial pressure” and laparoscopy assisted ventriculoperitoneal shunt treatment of hydrocephalus

作　　者：张涛[1] 王辉[1] 汪超甲[1] 李安荣[1] 周一[1] 成于思[1] 崔雨[1] ZHANG Tao;WANG Hui;WANG Chaojia(Department of Neurosurgery,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,China)

机构地区：[1]湖北省十堰市太和医院神经外科,十堰442000

出　　处：《临床外科杂志》2018年第7期501-503,共3页Journal of Clinical Surgery

摘　　要：目的探讨"阶梯式降压"及腹腔镜辅助下脑室-腹腔分流术治疗脑积水的临床应用价值。方法行脑室-腹腔分流术脑积水病人233例,其中腹腔镜辅助下手术63例,同期行直接开腹手术170例。术后均采用"阶梯式降压"的方法,统计分析二组患者在手术时间、平均住院时间、术后并发症发生率。结果腹腔镜组手术平均时间为(48±8.7)分钟,开腹组为(72±8.9)分钟。腹腔镜组平均住院时间为(7.2±3.8)天,开腹组为(10.3±5.2)天。两组比较差异均有统计学意义(P<0.05)。开腹组有5例出现术后感染(包括颅内感染4例,腹腔感染1例);6例远端梗阻,临床症状无明显缓解甚至恶化;1例术后颅内出血和脑室梗阻;1例表现分流过度最后拔除分流管;1例因术中肠穿孔死亡。腹腔镜组有1例颅内感染;1例因肿瘤死亡;其他均具有良好的预后,并没有与腹腔镜手术相关的并发症。结论在"阶梯式降压"的情况下,腹腔镜辅助下脑室-腹腔分流术具有手术时间短、创伤小、术后并发症少。Objective To explore the value of the clinical application for＂step-by-step down intracranial pressure ＂ and Laparoscopy-assisted ventriculoperitoneal shunt treatment of hydrocephalus.Methods 233 patients with hydrocephalus were treated by ventriculoperitoneal shunt,of whom 63 underwent laparoscopic assisted surgery,the same time directly laparotomy incision ventriculoperitoneal shunting has 170 cases. Postoperative step-down method was used,Statistical analysis of the operative time,the average hospital stay and the incidence of postoperative complications between the two groups. Results The average time of operation in laparoscopic group was（ 48 ± 8. 7） minutes,and the laparotomy group was（72 ± 8. 9）minutes. The average length of stay in the laparoscopic group was（7. 2 ± 3. 8） days,and the laparotomy group was（10. 3 ± 5. 2） days. The difference between the two groups was statistically significant（P〈0. 05）. In the open group,there were 5 cases of postoperative infection（including 4 cases of intracranial infection,1 cases of abdominal infection）,6 cases of distal obstruction,no obvious remission or even deterioration of clinical symptoms,1 cases of postoperative intracranial hemorrhage and ventricular obstruction,1 cases of excessive shunt to pull out shunt tube,1 cases died of intestinal perforation. In the laparoscopic group,there were 1 cases of intracranial infection,1 cases died of tumor,others had good prognosis,and there were no complications related to laparoscopic surgery. Conclusion Under the＂stepby-step down intracranial pressure＂,laparoscopic assisted ventriculoperitoneal shunt has shorter operative time,less trauma and fewer postoperative complications.

关 键 词：脑积水 脑室-腹腔分流术 “阶梯式降压” 腹腔镜 

分 类 号：R651.1[医药卫生—外科学]