脑室-腹腔分流术后分流不畅的原因分析及处理

Analysis of cause and countermeasures of poor diversion after ventriculoperitoneal shunt in patients with hydrocephalus

目的总结脑室-腹腔分流术后发生分流不畅的治疗经验。方法 2010年1月至2014年1月采用脑室-腹腔分流术治疗脑积水患者87例。结果术后出现分流不畅共6例,占6.90%(6/87)。梗阻性脑积水患者3例,远端和近端梗阻各1例,行神经内镜下第三脑室底造瘘术;远端堵塞1例,行脑室-心房分流术后好转。交通性脑积水患者3例,1例远端堵塞,行左侧脑室-腹腔分流术后好转;2例分流系统通畅但症状进行性加重,更换更低压力分流泵后好转。结论严格把握脑室-腹腔分流术指征,选择合适分流系统和手术方式,规范精细的手术操作有助于预防术后分流不畅的发生;脑室-心房分流术、第三脑室底造瘘术对分流不畅的治疗有较好作用。

Objective To explore the causes and treatment of ventricloperitoneal shunt （VPS） obstruction in the patients with hydrocephalus. Methods The clinical data of 6 patients with shunt system obstruction in 87 patients with hydrocephalus who underwent VPS from January, 2010 to January, 2014 were analyzed retrospectively. Results The rate of VPS system obstruction is 6.70% （6/87）. Of 6 patients with VPS system obstruction, 3 suffered from obstructive hydrocephalus and 3 communicating hydrocephalus before VPS. Of 3 obstructive hydrocephalus patients with VPS system obstruction, 1 with obstruction of proximal end VPS system and 1 with obstruction of distal end of VPS were recovered well after undergoing the endoscopic third ventriculostomy and 1 with obstruction of distal end of VPS system was recovered well after undergoing ventriculoatrial shunt. Of 3 communicating hydrocephalus patients with poor diversion VPS, 1 with distal end obstruction was recovered well after undergoing the left VPS and 2 with aggravated symptoms of hydrocephalus after VPS were recovered well after replacement of lower pressure pump. Conclusions The poor diversion after VPS can be prevented by strict surgery indications, appropriate surgical method and standard operation technique in the patients with hydrocephalus. It is suggested that the effects of the endoscopic third ventriculostomy and ventriculoatrial shunt on obstruction of the shunt system after VPS is good.