小儿脑积水脑室-腹腔分流术中腹腔端置管方法分析

Placement of intraperitoneal shunt tube during ventriculoperitoneal shunt for hydrocephalus in children

目的 探讨小儿脑积水脑室-腹腔分流术中腹腔端置管方法及效果。方法 回顾性分析2015年1月至2020年6月脑室-腹腔分流术治疗的85例小儿脑积水的临床资料。接受小切口开腹手术放置腹腔端分流管的脑室-盆腔分流术25例(开腹组),接受腹腔镜辅助脑室-盆腔分流术22例(腹腔镜+盆腔组),接受腹腔镜辅助脑室-膈下分流术28例(腹腔镜+膈下组)。术后随访36个月,对比分析三组的手术疗效。结果 三组手术出血、肛门排气时间、住院时间、术后1周临床缓解率、术后1周颅脑CT缓解率均无显著差异(P>0.05)。腹腔镜+盆腔组手术时间较开腹组和腹腔镜+膈下组显著缩短(P<0.05),而开腹组和腹腔镜+膈下组之间无统计学差异(P>0.05)。腹腔镜+膈下组术后并发症发生率(3.6%,1/28)明显低于开腹组(31.4%,11/35;P<0.05)和腹腔镜+盆腔组(31.8%,7/22;P<0.05),而开腹组和腹腔镜+盆腔组之间无统计学差异(P>0.05)。腹腔镜+膈下组再次手术率(0%)明显低于开腹组(17.1%,6/35;P<0.05)和腹腔镜+盆腔组(18.2%,4/22;P<0.05),而开腹组和腹腔镜+盆腔组之间无统计学差异(P>0.05)。结论 对于小儿脑积水脑室-腹腔分流术中腹腔端置管,应用腹腔镜辅助膈下置管,更加简捷、安全、可行。

Objective To investigate the methods of intraperitoneal shunt tube placement during ventriculoperitoneal shunt for the children with hydrocephalus. Methods The clinical data of 85 children with hydrocephalus who underwent ventriculoperitoneal shunt from January 2015 to June 2020 were retrospectively analyzed. The intraperitoneal shunt tubes were placed by small incision laparotomy in 25 patients(open group), by laparoscopic-assisted ventriculo-pelvic shunt in 22 patients(laparoscopic + pelvic group), and by laparoscopic-assisted ventriculo-subdiaphragmatic shunt in 28 patients(laparoscopic + subdiaphragmatic group). The postoperative follow-up was 36 months, and the surgical curative effects of the three groups were compared and analyzed. Results There were no significant differences in surgical bleeding, anal exhaust time, hospital stay, clinical remission rate 1 week after operation, and brain CT remission rate 1 week after operation among the three groups(P>0.05). The operation time of the laparoscopic + pelvic group was significantly shorter than those of the open and laparoscopic+subdiaphragmatic groups(P<0.05), while there was no statistical difference between the open and laparoscopic+subdiaphragmatic groups(P>0.05). The rate of postoperative complications of the laparoscopic+subdiaphragmatic group(3.6%, 1/28) was significantly lower than the open group(31.4%, 11/35;P<0.05) and the laparoscopic+pelvic group(31.8%, 7/22;P<0.05), while there was no statistical difference between the open and the laparoscopy+pelvic groups(P>0.05).The reoperation rate(0%) of the laparoscopic+subdiaphragmatic group was significantly lower than the open group(17.1%, 6/35;P<0.05) and the laparoscopic + pelvic group(18.2%, 4/22;P<0.05), but there was no statistical difference between the open and the laparoscopy + pelvic groups(P>0.05). Conclusions It is simpler, safer and more feasible to apply laparoscopic-assisted subphrenic placement of intraperitoneal shunt tube during the ventriculo-peritoneal shunt for children with hydrocephalus.