腹腔镜在脑室-腹腔分流术中的应用

Advantage of laparoscope in ventriculoperitoneal shunt

目的 :探讨内镜外科在脑室 腹腔分流术中应用的优势。方法 :利用腹腔镜将脑室 腹腔分流管末端固定于肝膈间隙 2 5例 ,常规脑室 腹腔分流手术 32例。观察术后颅内压、脑室前角指数和脑室体部宽度指数变化、分流管腹腔端梗阻率、术后感染发生率及Karnofsky评分。结果 :常规手术及应用腹腔镜技术均可显著缓解临床症状 ,应用腹腔镜技术和常规手术的腹腔端梗阻率为 12 %和 2 1.8% (P <0 .0 5 ) ,术后感染发生率分别为 4 %和 3.1% (P >0 .0 5 ) ,Karnofsky评分分别为 6 9.3± 11.3和 5 7.5± 10 .5 (P <0 .0 5 )。结论 :腹腔镜技术具有腹部切口小 ,创伤轻 ,手术操作空间大、分流管末端固定可靠 ,粘连及阻塞的几率明显减少等优点 ,是今后脑室

Objective: To discuss the advantages of endoscopic surgery in ventriculoperitoneal shunt (VPS)in the treatment of hydrocephalus. Methods: With the help of laparoscope the abdominal ends of the shunt system were placed in the hepato-diaphramatic spacein in 25 patients. After operations the changes in ICP, ventricular body width index, anterior horn index, obstructive and infection rates, and Karnofsky Scale were observed against those of 25 routine VPS patients. Results: Clinical symptoms of intracranial hypertension were in both groups. The obstructive rate and infective rate, and Karnofsky Scale are 12% and 21.8%(P<0.05), 4% and 3.1%, 69.3+11.3 and 57.5+10.5(P<0.05) respectively, in the laparoscope and the control groups. Conclusions: We consider VPS assisted by laparoscope placing the distal end of shunt system into hepato-diaphramatic space with avery effective surgical approach with so many vistues as micro-invasion, vast vision, low rate of adhesion and obstruction, convenient re-adjustment and few complications.