深静脉穿剌管在脑室腹腔分流术中的应用

Application of deep-vein indwelling catheter in ventriculo-peritoneal shunting

目的：针对传统脑室腹腔分流术存在的不足，对传统的脑室腹腔分流术进行改良。方法：交通性脑积水25例使用深静脉穿剌针经腹部反麦氏点穿刺，经穿刺针导入导引钢丝，拨出穿剌针，沿钢丝插入可撕裂“8F”可撕裂导管鞘，拨出导引钢丝，经导管鞘插入脑室腹腔分流管。结果：改良手术无需开腹，置入脑室腹腔端仅需3min，腹部皮肤切口长仅0．5cm，均无切口疝形成。术后10d头颅CT复查脑室缩小，间质水肿明显减轻22例，侧脑室过度缩小、分流过度者1例术后随访0．5～2a，全部病例未发生肠黏连、切口疝及腹腔脏器损伤情况。结论：改良手术具有操作简单、省时、微创、可靠、易于推广的优点，明显优于传统术式及经腹腔镜下置管术式。

AIM： To improve the traditional operative method of ventriculo-peritoneal shunting to avoid its shortages. METHODS： In 25 cases of communicating hydrocephalus, the deep-vein indwelling catheter was punctured by inverse McBurney point. The guide wire was inserted into the catheter and then the catheter was withdrawn. 8F catheter sheath was inserted along with guide wire. After that, the guide wire was withdrawn and then the catheter of ventriculo-peritoneal shunting was imported. RESULTS： During the modified operation, the incision on the abdomen was only 0.5 cm long, and the time for catheter insertion was only 3 min. CT on day 10 post-operation showed the shrinked ventricles and relieved interstitial edema in 22 cases. Excessive decrease of lateral ventricle due to immoderate shunt happened in 1 case. No incisional hernia was found. In the follow-up ranging 0.5 - 2 a, no cases suffered from ankylenteron, incisional hernia and organ injury. CONCLUSION： The modified indwelling catheter of ventriculo-peritoneal shunting has the advantages of convenience operation, saving time, minimal invasion and reliability. The modified operation is better than traditional one.