改良脑室—心房分流术29例报告

Twenty-nine cases with modified ventriculoatrial shunting

目的探讨深静脉穿刺置管术在脑室—心房分流术中的应用,尤其在外伤性脑积水已行胃造瘘或拟行胃造瘘患者中的应用。方法对29例外伤性脑积水患者术前行深静脉穿刺置管,摄X片定位,术中导入导引钢丝,拨出深静脉导管,沿导引钢丝插入"益心达"8F导管鞘,拨出导引钢丝,导人脑室—心房分流管,根据术前胸片,调整分流管深度。结果一次穿刺成功率96.6%,手术时间平均为45min。结论应用深静脉穿刺置管技术行脑室—心房分流术具有操作方便、手术时间短、创伤小、分流管远端放置准确、不需配备术中C臂X-线机等优点。

Objective To explore the application of deep-vein indwelling catheter in patients undergoing ventriculoatrial shunting, especially those with traumatic hydrocephalus who have undergone or go to be operated on by gastrostomy. Methods The deep-vein indwelling catheter was placed for the 29 patients with traumatic hydrocephalus prior to ventriculoatrial shunting. Puncture position selected through X-ray photographs, the guide wire was inserted into the catheter and the deep-vein catheter was withdrawn. Then the 8F catheter sheath （YIXINDA） was inserted along the guide wire. Eventually, the guide wire was withdrawn and then the ventriculoatrial shunt was imported, depths of the shunt adjusted according to preoperative sternum. Results The successful rate of puncture at the first attempt was 96.6% and the mean operative time was 45 min. Conclusion The ventriculoatrial shunting by deep-vein indwelling catheter has the advantages of simple, short in operation time, minimally invasive, precise in localization of the distal end of the shunt and needing no intraoperative C-arm X-ray apparatus and so on.