脑室腹腔分流手术治疗成人脑积水的临床分析

Clinical analysis on ventriculoperitoneal shunt in treating adult hydrocephalus

目的:探讨成人脑积水脑室腹腔分流(ventriculoperitoneal,VP)手术治疗及影响手术效果的相关因素。方法 :回顾性分析116例成人脑积水VP手术治疗,对术前、手术重要环节及重要因素进行总结分析。结果:本组成人脑积水116例VP手术治疗144次,明显好转75例,好转30例,无效8例,死亡3例。再手术26次,再手术率22.4%,其中分流管近端梗阻8例,远端梗阻16例(腹腔假性囊肿6例),近端与泵连接处断裂2例;感染10例,无腹腔脏器损伤病例。结论:CSF性状、术中脑室准确穿刺、引流管放置深度、分流管压力范围选择是决定VP手术成功的重要因素。采用立体定向理念指导脑室穿刺,从腹腔端建立引流管隧道的方法简单有效,可提高VP手术效果。

Objective：To explore the factors effecting the outcome and the management of adult hydrocephalus by ventriculoperitoneal shunt.Methods：116 cases of adult hydrocephalus received ventriculo-peritoneal shunt were analyzed,including related methods and important factors during preoperative and intraoperative periods.Results：In 116 cases of adult hydrocephalus received ventriculo-peritoneal shunt for 144 times,shunt failure occurred in 22.4% cases.75 cases got good recovery,30 cases were improved,8 cases were ineffectire,3 cases died,Re-operations were 26 times wicth the reoperation rate of 22.4%.There were 16 cases of distal catheter obstruction,including abdominal pseudocyst in 6 cases,8 cases got proximal catheter obstruction and 2 cases of catheters ruptured at the join point to the pump.10 cases got shunt infection.No cases got complication of abdominal viscus injury.Conclusion：The important factors determining the effect of operation include the condition of CSF,accurate ventricle puncture,adequate depth and pressure range of catheter.Applying the stereotaxis options to guide the cranial puncture.Establishing the subcutaneous tunnels from the abdominal end.can increase the operative effect.