腹腔镜辅助下脑室腹腔分流术的临床应用

Clinical Application of Ventriculoperitoneal Shunt Assisted by Laparoscope

目的 比较腹腔镜辅助下脑室腹腔分流术 (VPS)和常规剖腹 VPS的临床疗效 ,探讨腹腔镜辅助下VPS的临床应用经验。方法 回顾性总结分析 2 6例腹腔镜辅助下 VPS和 2 34例常规剖腹 VP分流术的临床资料 ,分析比较两种手术方式的手术效果及并发症发生率。结果 常规剖腹 VPS组 2 34例中 6例出现腹腔端梗阻、移位 ,5例出现术后感染 ,2例儿童患者出现分流管腹腔端穿破直肠脱出肛门。腹腔镜辅助下 VPS组 2 6例患者术后均恢复良好 ,症状均有不同程度的缓解 ,其中 13例采用右肝膈间隙分流术 ,13例采用盆腔分流术 ,除 1例发生术后感染外 ,无腹腔端梗阻、移位或穿破腹腔脏器发生者 ,且无与腹腔镜手术相关的并发症发生。结论 腹腔镜辅助下脑室腹腔分流术安全可靠 ,具有定位准、创伤小、术后并发症少等优点 ,有良好的临床应用前景。

Objective To compare the clinical effectiveness of ventriculoperitoneal shunt (VPS) assisted by laparoscope versus the clinical effectiveness of VPS via traditional laparotomy in treating hydrocephalus. Methods The clinical data on 26 cases of VPS with laparoscope assistance and on 234 cases of VPS via traditional laparotomy were summerized and analyzed retrospectively. The operation efficacy and the complication rate were compared between the two groups. Results In the traditional laparotomy group, there were 6 cases of peritoneal catheter obstruction or displacement, 5 cases of postoperative infection, and 2 childhood cases where the peritoneal catheter made a way into the rectum and through the anus. But in the laparoscope group, there was only one case of postoperative infection. Postoperatively the laparoscope group was better than the traditional laparotomy group in respect to the postoperative outcome, complication rate and the clinical improvement. Thirteen cases were treated by the VPS using right liver-diaphragm interspace drainage and another 13 cases were treated by the VPS using pelvis cavity drainage in the laparoscope group, respectively. Conclusion The technique of VPS assisted by laparoscopeis safe, reliable, and has the advantages of accurate positioning, minimal injury and less postoperative complications; it is worthy of clinical application and popularization. Positioning the peritoneal catheter to the liver-diaphragm interspace can avoid the complications caused by perforation of the cavity organs.