改良侧脑室枕角穿刺行V-P分流术治疗脑积水(附30例分析)

Modified ventricle occipital horn puncture in ventricle-peritoneal shunt for treatment of hydrocephalus( analysis of 30 cases )

目的探讨改良侧脑室枕角穿刺行脑室-腹腔(V-P)分流术在脑积水患者手术治疗中的应用价值。方法对30例脑积水患者根据术前CT或MR定位外耳道层面扫描基线,选择穿刺层面及穿刺路径,定位枕角穿刺点(A)及穿刺路径延伸至对侧额部皮肤交点(B),并于患者头部体表定位。A点作直线(AC)平行与扫描基线,A、B两点间作一直线(AB)连接。术前患者仰卧头侧位,垫高穿刺侧肩部,以使AB连线处于水平位置,术中以A点为穿刺点,穿刺针平行与AC线,水平进针即能进入侧脑室枕角,实现V-P分流术。分析随访结果,包括临床症状,侧脑室大小,分流管位置及并发症。结果一次操作成功28例,另2例稍作调整后二次操作成功;术后头颅CT复查均见脑室分流管在位;29例患者的脑室明显回缩或临床症状改善,穿刺道出血1例,保守治疗后好转。术后感染2例,抗炎治疗后好转。结论改良侧脑室枕角穿刺行V-P分流术操作方法简便、省时,穿刺准确,完善手术细节,可进一步推广。

Objective To explore the value of modified ventricle occipital horn puncture in ventricle-peritoneal （V-P） shunt for the treatment of hydrocephalus patients. Methods 20 hydrocephalus patients underwent CT or MR scan. Located scanning baseline in external auditory canal plane and chose largest ventricle as puncture plane and designed hypothetical puncture path on axial slice radiographic film. Located occipital horn puncture point（A） and puncture path extend to contra-lateral frontal （Point B）. Connected A and B （AB line） and made AC line parallel to scanning baseline on the skin surface. Intra operation turned head to another side and made AB line horizontal position, puncture needle parallel to AC line and horizontally puncture. Analized follow-up results including clinical symptoms,ventrieular size,position of catheter and complications. Results Success rate of the only one puncture reached 28 case, another 2 cases succeeded in second time puncture after a little adjustment. Follow-up CT scan disclosed smaller ventricular in 25 cases, right position of catheter. Clinical symptoms relieved in 29 cases, hemorrhage in 1, postoperative infection in 2 recovered after conservative treatment. Conclusion Modified ventricle occipital horn puncture in ventricle-peritoneal shunt is convenient, time saved, accurate ,which could be extended.