儿童颅内蛛网膜囊肿分流术后分流管临时结扎

Ligation of the shunt tube in children with intracranial arachnoid cysts： how to removal the shunt device timely and safely

目的 探讨儿童颅内蛛网膜囊肿分流术后分流管结扎并安全拔除的可能性。方法选择2004年1月至2009年12月在天津市环湖医院进行囊肿-腹腔分流的9例患儿，在分流术后6个月随访囊肿消失或缩小，直至2年囊肿无变化者，于皮下分流管最明显部分进行结扎，然后继续随访（平均2．4年）观察。结果9例患儿有4例在术后平均6个月时囊肿消失；5例中颅窝囊肿在随访6个月时病变缩小，症状消失；继续随访囊肿未见增大；1例囊肿在12个月时消失；结扎分流管后平均随访2．4年没有任何异常表现，影像学未见囊肿复发或原有囊肿增大。结论囊肿-腹腔分流管在囊肿消失或稳定后平均2年可以试行临时结扎，再继续随访，如长时间无变化可以考虑拔除分流管。

Objective In the past decade, thousands of the pediatric patients with intracranial arachnoid cysts （ ACs ） undertook the operation of the cyst - peritoneal shunt （ C - Ps ）. More and more complications caused by the insertion and long time staying in the body of the shunt device were reported in recent years. Therefore, it is just the aim of this article to make clear how to removal the shunt device timely and safely. Method 9 pediatric patients hospitalized in Tianjin Huanhu Hospital from January 2004 to December 2009 were taken into the study. We investigated the clinical symptoms and neuroimaging findings just at the time of 6 months after C - Ps. If the cyst disappear or reduce in size were found, follow - up would be continue for 2 years. When the change of the cyst in size could not be found, ligating of the shunt tube would be performed at an appropriate position subcutaneously, and a long time follow - up would be performed. Results The cysts disappeared in 4 out of 9 patients in an average 6 months of follow - up. At the same period the cysts reduced in size in 5 patients. No symptom or sign were found during the following up of 2.4 years after the shunt tube ligation. Conclusions Ligating of the shunt tube can be tried after 2 years of C - P shunt without any change in cyst size and clinical symptoms. The removal of the shunt device will be carried out finally.