继发性脑积水非计划再次手术6例分析

Clinical Analysis of Unplanned Re-operation for 6 Cases of Secondary Hydrocephalus

目的分析继发性脑积水非计划再次手术的原因和对策。方法2016年3月至2019年4月,广东医科大学附属医院神经外科收治继发性脑积水非计划再次手术患者6例,总结其临床资料,并提出避免或减少其发生的对策。结果在6例非计划手术的患者中,有脑室腹腔分流系统堵塞但未感染者4例(脑室段2例,阀门处1例,腹腔段1例),均予更换分流管;感染但未堵塞者2例,予去除分流装置行脑室外引流,并抗感染治疗,待感染控制后重行脑室腹腔分流术。经过处理后5例脑积水缓解,1例因全身脓毒血症死亡。结论继发性脑积水非计划再次手术发生原因常为分流系统阻塞及感染,为避免非计划再次手术的发生,建议行初次脑室腹腔分流术时,应注意无菌操作和尽可能一次穿刺到位,应尽量缩短手术时长和及时清理出血形成的血凝块,术后应常规抗感染治疗,发现堵塞与感染应尽早处理。

Objective To analyze the causes and countermeasures of unplanned re-operation for secondary hydrocephalus.Methods Clinical data were retrospectively analyzed in 6 patients with secondary hydrocephalus who underwent unplanned re-operation in the Department of Neurosurgery,Affiliated Hospital of Guangdong Medical University from March 2016 to April 2019.Results In the 6 unplanned operation,it was found the ventriculoperitoneal shunt system blockage located at the middle ventricle segment of 2 cases,at the valve of 1 case and at the abdominal segment of 1 case.All the blocked shunt tubes were replaced.In 2 cases of infection only,it was performed of the the shunt device removal,anti-infection,external ventricular drainage and the second ventriculoperitoneal shunt following infection control.After treatments,5 cases of hydrocephalus obtained remission but 1 case died of systemic sepsis.Conclusions Unplanned re-operation of secondary hydrocephalus is usually caused by obstruction and infection of the shunt system.In order to avoid the occurrence of unplanned re-operation,it is suggested to pay attention to the aseptic technology and achieve the puncture position timely and accurately for the primary ventriculoperitoneal shunt.Operation time should be tremendously shortened and the blood clot should be cleaned in time.The routine postoperative anti-infection treatment should be used.If blockage and infection are found in the ventriculoperitoneal shunt patients,they should be handled as soon as possible.