脑室膀胱分流在临床中的应用

The clinical application of ventriculovesical shunts

目的 探讨对不适合做脑室腹腔(VP)分流的患者进行脑室膀胱分流的临床应用价值。 方法 自2000年3月至2016年3月,共有25例患者脑积水接受脑室膀胱分流手术,年龄5-68岁,在做脑室膀胱分流之前,既往均有VP分流失败病史,VP分流原因包括腹腔包裹性积液11例,腹膜对脑脊液不吸收导致腹水7例,术后腹腔反复感染5例,腹腔刺激性疼痛不耐受2例。所有脑室膀胱分流患者术前均进行膀胱充盈状态的B超检查,行尿液常规及培养检查,以及肾功能检查。 结果 2例患者因其他疾病导致死亡,1例患者术后2年头端分流管堵塞,予以更换头端分流管,症状改善;1例患者术后4年出现阴茎放射性疼痛,其余患者脑积水缓解满意。 结论 脑室膀胱分流术对于不能做腹腔分流的患者是有效的,可以作为一种有效的手术方案进行临床应用。

Objective To report a clinical protocol for the application of ventriculovesical shunts (VV shunts) in patient who may be unable to maintain or receive ventriculoperitoneal (VP) shunts. Methods 25 patients underwent placement of VV shunts as an alternative to VP shunt therapy from March 2010 through March 2016. They all have malfunction of the VP shunt for the following reasons: peritoneal fluid inclusion(11 cases), failure of the peritoneum to absorb cerebrospinal fluid(7 cases), intra-abdominal infection(5 cases), peritoneal irritation pain(2 cases). The patients ranged in age from 5 years to 68 years old. All the patients underwent preoperative examine including urine routines, renal function electrolyte examination, imaging of the urinary bladder by ultrasonography. Results Two patients died from other diseases, one patient′s shunts were removed due to proximal catheter occlusion 2 years after the operation, the penis pain was occurred in one patient. The rest patients had functional VV shunts. Conclusions Ventriculovesical shunts may be considered for the treatment of hydrocephalus when the peritoneal cavity cannot be used as a distal terminus.