脑室-腹腔分流术后早期并发症调查研究

A study on early postoperative complications of ventriculo-peritoneal shunt in treatment of hydrocephalus

目的探讨脑室-腹腔分流术后早期并发症发生率,以为其临床预防和治疗提供参考依据。方法采用前瞻性、非随机、无对照随访研究方法分析115例脑室-腹腔分流术患者手术后并发症发生率及临床处理方法。结果 115例患者,2例失访,3例死亡,余110例均随访至手术后90 d。36例患者(32.73%)发生并发症,其中分流管脑室端置入位置异常17例(15.45%);11例脑脊液引流通畅,未予处理,6例再次手术重新置管。余19例分别为分流管相关性感染6例(5.45%)、脑实质或脑室出血4例(3.64%)、过度分流4例(3.64%)、分流管堵塞3例(2.73%)、分流管皮下隧道破溃2例(1.82%);17例手术修管或择期再次手术,余2例保守治疗。结论现代医学条件下,脑室-腹腔分流术后并发症发生率仍较高,详细的手术前评价及严格的手术中规范化操作,是降低脑室-腹腔分流术后早期并发症发生率的重要举措。

Objective To investigate the incidence of early postoperative complications in patients treated with ventriculo-peritoneal shunt （VPS）, and to provide evidences for related clinical prevention and treatment. Methods One hundred and fifteen patients with hydrocephalus, who underwent VPS at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, were enrolled in this prospective, non- randomised, uncontrolled, follow-up study from September 2006 to February 2009. The patients were 10 months to 75 years in age, 69 males and 46 females. Patients were followed for 90 d after operation. The incidence and clinical treatment of postoperative complications were analysed. Results In 115 patients, 2 cases were loss of follow-up, and 3 died during the follow-up period. Rest of the patients completed the 90- day follow-up study. Out of 110 patients, 36 cases （32.73%） experienced postoperative complications. The location of ventricle catheter was abnormal in 17 patients （15.45%）, in which 11 cases with adequate drainage were not treated, while other 6 cases were reoperated for replacement of new shunt catheter. VPS related infection occurred in 6 patients （5.45%）. Occurrences of ventricular or intracerebral hemorrhage and overdrainage were 3.64%, for all. Obstruction of shunt catheter was seen in 3 patients （2.73%） and shunt catheter destruction in subcutaneous tunnel was found in 2 patients （1.82%）. Catheter repairment or selective reoperation were performed in 17 patients, and conservative treatment was given in 2 patients. Conclusion Under modern medical condition, the incidence of postoperative complieations in VPS is still high. Careful preoperative evaluation and strict standarized operation are important measures for redueing the incidence of early stage complications after VPS.