腹腔镜快速建立脑室腹腔分流术腹腔端放置技术的临床研究

Design and practice of the position of the tip of in ventriculo-peritoneal cavity shunting under laparoscope

[目的]探讨腹腔镜脑室-腹腔分流术（管）腹腔端放置技术的设计和实施方法。[方法]本组34例，其中外伤性脑积水20例，先天性脑积水2例，脑肿瘤引起的梗阻性脑积水5例，交通性脑积水7例。患者均采用腹腔镜技术进行脑室-腹腔分流术，侧脑室穿刺成功后置入分流泵（管），腹腔端经颈胸皮下隧道进入腹腔，以钛夹固定于右侧膈下和肝圆韧带。[结果]本组患者手术置管顺利，腹腔镜组手术时间仅需5～8min。随访6—24个月，平均15个月，5例发生引流管的脑室端阻塞，引流不畅，其中2例经冲洗导管内积血，另3例经调整脑室内导管位置后，引流恢复通畅。术后颅高压症消失，未发生与腹腔镜手术相关的并发症。[结论]腹腔镜脑室一腹腔分流术操作简单快捷，微创，腹腔内炎症反应轻微。人工气腹使肝膈间隙显露良好，视野大而开阔，手术操作空间大，分流管腹腔端粘连和堵塞的可能性小，分流效果可靠。

[Objective] To approach the position and method of the tip of diffluence tube in ventriculo-peritoneal cavity shunting （V-P shunting）. [Methods] Laparoscoplic V-p shunting was processed in 34 eases （20 traumatic hydrocephalus, 2 congenital hydrocephalus, 5 obstructive hydrocephalus caused by brain tumour and 7 communicating hydrocephalus. ） in our hospital, After ventricular puncture, the diffluence catheter was inserted into lateral ventricule, the tip of diffluence tube enter abdominal cavity through subcutaneouly tunnel of neck and thorax. The tube was fixed it on the right diaphragm at liver surface and ligament teres hepatis by titanium clips. [Results] The tube was successfully placed in all patients, Operation time of laparoscope group was only 5 - 8 minutes. Follow-up was made in all cases for 6 - 24 months （average 15 months） after operation. 5 cases occured shunt obstraction at tip of ventricle, 2 cases irrigated hematocele in catheter , 3 cases adjusted location of catheter, drainage was unobstructed and without laparoscope complications. Intracranial hypertension disappeared. [Conclusion] V-P shunting with laparoscope is a simple technique with quickly, minimal invasion, inflammatory reaction lightly in cavity, better exposure of hepato-diaphragm with pneumoperitoneum, larger field for operation and obviously less possibility of adhesion and obstrution of catheter terminal.