可调压式分流管治疗小儿脑积水的临床观察

Clinical efficiency of programmable shunt valve in treatment of hydrocephalus in children

目的总结可调压式分流管治疗小儿脑积水的经验,探讨其临床应用价值。方法回顾性分析24例植入可调压式分流管治疗的不同类型脑积水患儿的病情转归。患儿均行脑室-腹腔分流术,根据术中脑脊液测压结果并结合患儿临床表现、影像学检查等因素设定调压阀开放压力的初始值,术后根据患儿临床表现的改善情况及影像学复查结果进行调压阀开放压力调整。结果术后调压次数0～4次,平均2.6次。随访3～28个月,患儿临床症状均明显缓解或消失,CT检查显示脑室均较术前缩小。术后感染2例,分流管梗阻1例。结论可调压式分流管具有压力设定个体化的优点,在小儿脑积水治疗中疗效优于固定压力分流管,可有效避免术后分流过度和分流不足的出现。

Objective To summarize our experience and assess the clinical value of the programmable shunt valve in treatment of hydrocephalus in children.Methods A total of 24 children（at age of 8 months to 11.2 years old,and mean age of 5.7 years old） with hydrocephalus who underwent Ventriculo-peritoneal（V-P） shunt surgery and programmable valve implantation during operation were retrospectively analyzed.The opening pressure was settled based on intraoperative intraventricular pressure,clinical manifestation and imaging results.Postoperative regulator opening pressure was adjusted according to clinical improvement and imaging results after operation.Results After operation,adjusting valve pressure was performed for 0 to 4 times,mean 2.6 times.All the cases were followed up for 3 to 28 months,and their clinical symptoms were relieved or disappeared.CT examination showed size of ventricle was reduced compared with preoperative in all cases.Postoperative infection was found in 2 cases,and shunt obstruction in 1 case.Conclusion Programmable shunt valve has the advantages of individual pressure setting,and effectively preventing excessive and insufficient segregation postoperatively.