腹腔镜辅助下侧脑室经腹腔暂时性外引流治疗脑积水

Laparoscopic ventriculoperitoneal shunt with temporary external drainage for hydrocephalus:a comparison with conventional ventriculoperitoneal shunt

目的探讨腹腔镜辅助下侧脑室经腹腔暂时性外引流术的临床应用价值。方法将确诊为脑积水的52例入组患者按随机数字表随机均分为两组,一组接受腹腔镜辅助下侧脑室经腹腔暂时性外引流术(简称腔镜辅助外引流组)(共26例,男19例,女7例)和另一组接受常规侧脑室-腹腔分流术(简称常规分流组)(共26例,男20例,女6例),比较两组患者腹腔置管手术时间、颅内高压症缓解时间、平均住院时间、术后疼痛程度和术后并发症发生情况。结果 26例腔镜辅助外引流组患者均在腹腔镜下成功完成手术,无1例中转开腹。与常规分流组比较,腔镜辅助外引流组的腹腔置管手术时间、颅内高压症缓解时间和平均住院时间均明显缩短(P<0.01);术后4、8、16、24 h疼痛评分低(P<0.01),但术后48 h和72 h的疼痛评分两组比较无差异(P>0.05)。术后随访3个月,腔镜辅助外引流组分流管腹腔端梗阻和腹腔感染发生率均低于常规分流术组(3.8%∶19.2%,P<0.01,Pearsonχ2检验;1.0%∶23.1%,P<0.01,校正χ2检验)。结论腹腔镜辅助下侧脑室经腹腔暂时性外引流术治疗脑积水引流确切、置管准确、观察直接,而且操作便捷,可取得较好的临床治疗效果。

Objective To investigate the clinical efficacy of laparoscopic ventriculoperitoneal shunt with temporary external drainage in the treatment of hydrophalus. Methods Fifty-two cases of hydrocephalus randomized into two groups to receive laparoscopic assisted ventriculoperitoneal shunt with temporary external drainage （19 male and 7 female patients） and conventional ventriculoperitoneal shunt （20 male and 6 female patients）. The catheterization time in the abdominal cavity, release time of intracranial hypertension, average hospital stay, postoperative pains, and postoperative complications were compared between the two groups. Results Laparoscopic ventriculoperitoneal shunt with temporary external drainage was performed successfully in all the cases without intraoperative conversion to open surgery. Compared with the conventional ventriculoperitoneal shunt, laparoscopic ventriculoperitoneal shunt with temporary external drainage was associated with significantly shortened catheterization time in the abdominal cavity, release time of intracranial hypertension, and average hospital stay （P〈0.01） as well as lowered postoperative pain score at 4, 8, 16, and 24 h after the operation. The pain scores at 48 and 72 h postoperatively were comparable between the two groups. During the follow-up 3 months, the patients receiving laparoscopic ventriculoperitoneal shunt were found to have significantly lower rates of peritoneal end obstruction and abdominal cavity infection than those having conventional shunt （3.8% vs 19.2%, P〈0.01; 1.0% vs 23.1%, P〈0.01）. Conclusion Laparoscopic ventriculoperitoneal shunt with temporary external drainage is feasible and produces better clinical therapeutic effect for management of hydrocephalus.