腔镜技术治疗脑积水

Aparoscope or/and ventriculoscope in the treatment of hydrocephalus

目的:探讨腔镜技术对不同性质脑积水的治疗及其效果。方法:应用腹腔镜、神经内窥镜及神经内窥镜与腹腔镜联合应用技术,对93例脑积水进行治疗。腹腔镜治疗组(应用腹腔镜行V-P肝膈间隙分流术)52例,神经内窥镜治疗组41例(包括与腹腔镜联合应用治疗5例),采用透明隔造瘘术23人次,脉络丛电灼术18人次,第三脑室底造瘘术18人次,脑室内囊肿造瘘术11人次,分流管脑室端调整术8人次,鞍区囊性肿瘤并发脑积水的神经内窥镜手术7例,神经内窥镜与腹腔镜联合应用下侧脑室—肝膈间隙分流术5例,松果体区病变并发脑积水的神经内窥镜手术3例。结果:随访3个月至4年,应用腹腔镜行V-P肝膈间隙分流术治疗脑积水优于常规V-P手术;神经内窥镜治疗41例,其中35例有效,6例无效,无严重并发症。结论:应用腹腔镜、神经内窥镜及神经内窥镜与腹腔镜联合应用技术可使大部分脑积水得到控制,使手术成功率明显提高,减少并发症。

Objective： To explore the effect of aparoscope or/and ventriculoscope on hydrocephalus. Methods： Ninety-three cases of hydrocephalus were treated by aparoscope or/and ventriculoscopic techniques. Among them, 52 cases were subjected to ventriculo-hepato-diaphramatic space shunt under aparoscope; 41 cases were treated under ventriculoscope, of them, 23 cases were subjected to septa pellucidum fistulation, 18 cases to choroid plexus electrofulguration, 18 cases of occlusive hydrocephalus neuroendoscopic third ventriculostomy, 11 cases of cyst fistulation in ventricle, 8 cases to adjustment of the shunt channel ventricle tip, 7 cases of saddle cystic tumor combined with hydrocephalus neuroendoscopy, 5 cases of ventriculo-peritoneal （V-P） shunt by neuroendoscopy combined with laparoscopy, and 3 cases of pineal tumor combined with hydrocephalus neuroendoscopy. Results： After a follow-up of 3 months to 4 years, the ventriculo-hepato-diaphramatic space shunt for hydrocephalus under aparoscopy was superior to routine ventriculo-peritoneal shunt for hydrocephalus. Of the 41 cases treated by ventriculoscopy, 35 improved and 6 did not. Conclusion： Most hydrocephalus can be treated by neuroendoscopy or ventriculoscopy associated with aparoscopy.