反麦氏点入路腔镜辅助下脑室-腹腔分流术治疗脑积水的疗效分析

Analysis of the therapeutic efficacy of laparoscopic-assisted ventriculoperitoneal shunt in the treatment of hydrocephalus in inverse McBurney point approach

目的:探讨反麦氏点入路腹腔镜脑室-腹腔分流术治疗脑积水的安全性。方法:分析2021年8月至2022年12月为87例脑积水患者行脑室-腹腔分流术的临床资料,其中腹腔镜组(L组,n=43)先于腹腔镜下观察反麦氏点的解剖结构,然后镜下将腹腔端分流管经反麦氏点置入盆腔;传统组(T组,n=44)的腹腔端分流管经反麦氏点切口置入盆腔。比较两组术后第1天、第3天白细胞、中性粒细胞情况及术中出血量、手术时间等相关指标。结果:两组均成功完成手术。与T组相比,L组术后第1天、第3天白细胞、中性粒细胞均较低(P<0.05),术中出血量较少(P<0.05),手术时间、住院时间短(P<0.05),术后6个月内腹腔端分流管堵塞率差异无统计学意义(P>0.05)。L组43例患者镜下观察到肠蠕动方向为顺时针,反麦氏点周围无大血管及神经分布。结论:反麦氏点位置固定,解剖变异小,周围缺乏大血管及神经分布,腹腔端分流管入腹后顺应了肠蠕动方向,不容易发生堵管,同时腹腔镜创伤小、术后康复快,因此腹腔镜辅助下反麦氏点入路的脑室-腹腔分流术是安全、可靠的,值得临床推广应用。

Objective:To investigate the safety of laparoscopic-assisted ventriculoperitoneal shunt surgery via the inverse McBurney point approach for the treatment of hydrocephalus.Methods:Clinical data of 87 patients with hydrocephalus who underwent ventriculoperitoneal shunt surgery from Aug.2021 to Dec.2022 were analyzed.Among them,43 cases were in the laparoscopic group(L group).In this group,the anatomical structure of the inverse McBurney point was observed under laparoscopy,and the peritoneal end of the shunt tube was placed into the pelvic cavity under direct laparoscopic vision.The remaining 44 cases were in the traditional group(T group),in which the peritoneal end of the shunt tube was placed into the pelvic cavity through an incision at the inverse McBurney point.The postoperative white blood cell count,neutrophil count at 1 and 3 days after surgery,intraoperative blood loss,operative time and other parameters were compared between the two surgical methods.Results:Both groups successfully completed the surgery.Compared with the T group,the L group showed reduced white blood cell and neutrophil counts at 1 and 3 days after surgery(P<0.05),d ecreased intraoperative blood loss(P<0.05),shorter operation time and hospital stay(P<0.05).The shunt tube blockage rate within six months after surgery showed no significant difference between the two groups(P>0.05).Laparoscopic observation revealed that the intestinal peristalsis direction of the 43 patients in the L group was clockwise,and there were no major blood vessels or nerves around the inverse McBurney point.Conclusions:The inverse McBurney point is a fixed anatomical location with minimal anatomical variation,and it lacks major blood vessels and nerve distribution around it.The peritoneal end of the shunt tube follows the direction of intestinal peristalsis after entering the abdomen,reducing the likelihood of tube blockage.Moreover,laparoscopic-assisted ventriculoperitoneal shunt surgery via the inverse McBurney point approach is a safe and reliable method for treating hydrocephalus,characterized by minimal invasiveness and rapid postoperative recovery.Therefore,it is worthy of clinical promotion and application.