腹腔穿刺微创置管术在脑积水腹腔分流术中的应用

Application of peritoneal catheter via pneumoperitoneum puncturation in cerebral spinal fluid peritonealshunt surgery

目的 探讨气腹下腹腔穿刺置管术在脑积水腹腔分流术中的应用价值.方法 回顾性分析2002年6月至2016年12月浙江省立同德医院收治的490例脑积水患者的临床资料,以2002年6月至2009年1月采用开腹置入分流管行脑室-腹腔分流术（VPS）的147例为对照组（开腹置管组）,以2009年2月至2016年12月采用腹腔穿刺置入分流管行分流术的343例为观察组（腹腔穿刺置管组）;再将腹腔穿刺置管组患者按置管方式不同分为VPS组228例和腰大池-腹腔分流术（LPS）组115例.收集开腹置管组和腹腔穿刺置管组患者术后6个月感染、分流管堵塞（堵管）、出血和其他并发症（如引流不足或过度、出血、癫痫、肠梗阻）发生情况等临床资料,比较各组并发症发生率的差异.结果 开腹置管组感染〔10.20%（15/147）比3.79% （13/343）〕、堵管〔14.29%（21/147）比7.58%（26/343）〕和其他并发症〔23.13%（34/147）比10.79%（37/343）〕发生率明显高于腹腔穿刺置管组（均P〈0.05）;VPS组堵管率明显高于LPS组〔9.65%（22/228）比3.48%（4/115）, P〈0.05〕.结论 气腹下腹腔穿刺置入分流管行脑积水分流术操作简便、安全,能有效降低感染率和堵管率;其中LPS堵管发生率比VPS更低.

Objective To discuss the application value of the peritoneal catheter via pneumoperitoneum puncturation in cerebral spinal fluid （CSF） peritoneal shunt surgery. Methods The clinical data of 490 hydrocephalus patients admitted to Zhejiang Provincial Tongde Hospital from June 2002 to December 2016 were retrospectively analyzed, among them 147 cases accepted ventriculoperitoneal shunt （VPS） operation from June 2002 to January 2009 were assigned as a control group （open abdomenal catheterization group）, and 343 cases accepted pneumoperitoneum puncturation from February 2009 to December 2016 were arranged as an observation group （abdominal paracentesis group）. The patients in the abdominal paracentesis group were further subdivided into a VPS group （228 cases） and a lumboperitoneal shunt （LPS） group （115 group） according to different ways of catheterization. The clinical data such as infection, shunt obstruction （blockage）, bleeding and other complications （such as insufficient or excessive drainage, bleeding, epilepsy, intestinal obstruction） 6 mouths after operation were collected in open catheterization group and abdominal paracentesis group, the difference of incidences of complication in each group were compared. Results The incidences of infection [10.20% （15/147） vs. 3.79% （13/343）], shunt obstruction [14.29% （21/147） vs. 7.58% （26/343）], other complications [23.13% （34/147） vs. 10.79% （37/343）] in open catheterization group were significantly higher than those in abdominal paracentesis group （all P 〈 0.05）; the rate of shunt obstruction in VPS group was higher than that in LPS group [9.65% （22/228） vs. 3.48% （4/115）, P 〈 0.05]. Conclusions Pneumoperitoneum puncturation is a simple, safe, minimally invasive technique to implant an abdominal cavity shunt catheter in CSF peritoneal shunt surgery, and it can effectively reduce the rates of infection and shunt blockage; LPS is more effective than VPS in reducing the incidence of the blockage by this paracentesis method.