脑室-腹腔分流术治疗小儿脑积水136例的疗效及并发症分析

Efficacy and complication of ventriculoperitoneal shunt in the treatment of 136 children with hydrocephalus

目的通过对疗效及并发症的分析,评估脑室-腹腔分流术在小儿脑积水治疗中的作用并为并发症应对策略的制定提供理论依据和科学基础。方法复习本组136例经脑室-腹腔分流术治疗的先天性脑积水及颅内出血、神经系统感染和颅脑外伤所致的继发性脑积水病例资料,对手术疗效及术后并发症进行统计分析。结果全部136例患儿均在术后1~12个月内经CT或MRI扫描完成首次复查,此后定期复查至随诊截止,侧脑室均较术前明显缩小甚至恢复正常大小,且侧脑室角均较术前锐利。共32例出现术后并发症(23.53%),其中细菌性感染12例(8.82%),脑室端(近端)阻塞7例(5.15%),腹腔端(远端)阻塞5例(3.68%),分流阀阻塞3例(2.21%),硬膜下积液1例(0.74%),分流管远端退出腹腔2例(1.47%),分流管脱出体表1例(0.74%),脑脊液漏1例(0.74%),无术后死亡病例。结论脑室-腹腔分流术是治疗小儿先天性及继发性脑积水的成熟可靠的方法,疗效显著,脑积水情况术后均可获得不同程度的改善,但须正确施行手术并加强围手术期护理,积极预防及处理术后并发症。

Objective To evaluate the role of ventriculoperitoneal shunt （ VPS） in the treatment of hydrocephalus in children by analyzing the efficacy and complications, and to provide theoretical basis and scientific basis for the development of preventive solution. Methods The data of congenital and secondary hydrocephalus caused by intracranial hemorrhage, neurological infection and traumatic brain injury cases which were treated through VPS were reviewed. The results of operation and postoperative complications were statistically analyzed. Results All 136 cases of children were examined by CT scan within 1 to 12 months after operation. The ventricle was significantly reduced compared with that before operation, the lateral ventricle angle was even restored to normal size, and the lateral ventricle angle was sharp. A total of 32 cases had postopera-tive complications （23.53% ） , including bacterial infection in 12 cases （8. 82% ） , ventricular end （proximal end） obstruc-tion in 7 cases （5. 15% ） , abdominal cavity （distal end） obstruction in 5 cases （3.68% ）,shunt valve obstruction in 3 ca-ses （2. 21 % ） , postoperative subdural effusion 1 case （0. 74%）,Shunt tube out of the abdominal cavity in 2 cases （1. 47% ）,shunt off the body surface in 1 case（0. 74% ） , cerebrospinal fluid leakage in 1 case （0. 74% ）,no postoperative death case. Conclusion Ventriculoperitoneal shunt is an effective method for the treatment of congenital and secondary hy-drocephalus in children. The curative effect is significant and the hydrocephalus can be improved in different degrees after op-eration. However, the operation should be performed correctly and the perioperative period care, active prevention and treat-ment of postoperative complications should be payed more attention to.