摘要/Abstract

摘要： 目的·比较二孔法腹腔镜辅助脑室腹腔分流术（laparoscopy-assisted ventriculoperitoneal shunt，LAVPS）与传统开腹脑室腹腔分流术（open ventriculoperitoneal shunt，OVPS）的临床疗效，探讨二孔法LAVPS中腹腔端分流管放置的临床实践与经验。方法·回顾性分析上海交通大学医学院附属仁济医院神经外科2016年1月—2018年12月收治的因脑积水行脑室腹腔分流术（ventriculoperitoneal shunt，VPS）的308例患者。其中，LAVPS治疗组（L组）90例，应用二孔法以及独创的线环法，将腹腔端分流管置入右肝膈间隙；传统OVPS治疗组（O组）218例，腹腔端分流管经剑突下正中切口置入左下腹。对比2种手术方式的手术时间和远端导管并发症等情况。结果·与O组相比，L组平均手术时间显著减少（54 min vs 90 min，P0.000），远端导管并发症发生率也显著降低（0 vs 9.6%，P0.002）。L组仅发生1例内脏损伤，1例远端导管移位，另发生1例近端导管堵塞；远端导管未有感染或堵塞，发生率均较O组显著降低（0 vs 4.6%，P0.039；0 vs 5.0%，P0.030）。O组则发生10例导管感染，11例导管堵塞，4例内脏损伤，2例切口疝。结论·经改良的以线圈引导、腹腔端分流管留置于右肝膈间隙的二孔法LAVPS是一种安全、经济和简便的手术方法，与传统OVPS相比，能够更为有效地治疗各种原因所致的脑积水。
关键词: 脑积水, 腹腔镜, 脑室腹腔分流术, 肝膈间隙, 远端导管
Abstract:
Objective · To compare the clinical outcomes between two-trocar laparoscopy-assisted ventriculoperitoneal shunt (LAVPS) and conventional open ventriculoperitoneal shunt (OVPS), and explore the clinical practice and experience of the placement of distal catheter in two-trocar LAVPS. Methods · A total of 308 patients with hydrocephalus who underwent ventriculoperitoneal shunt (VPS) January 2016 to December 2018 in the Department of Neurosurgery at Renji Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Among them, there were 90 patients in the LAVPS group (Group L), and the two-trocar method and the original suture loop method were adopted to place the distal catheter in the right hepato-diaphragmatic space. For the other 218 patients in the conventional OVPS group (Group O), the laparotomy approach was adopted to put the distal catheter into the left lower abdominal cavity through the midline incision. The operation time and complications of the distal catheter between the two groups were compared. Results · Compared with Group O, the mean operation time was significantly reduced in Group L (54 min vs 90 min, P0.000), and the incidence of distal catheter complications was also significantly decreased (0 vs 9.6%, P0.002). In Group L, only one case of visceral injury, one case of distal catheter migration and one case of proximal catheter obstruction occurred. The incidences of infection and obstruction of the distal catheters were 0 in Group L, significantly lower than those in Group O (0 vs 4.6%, P0.039; 0 vs 5.0%, P0.030). In Group O, 10 cases of distal catheter infection, 11 cases of obstruction, 4 cases of visceral injury and 2 cases of incisional hernia occurred. Conclusion · The modified two-trocar LAVPS, of which the distal catheter was guideda suture loop method and placed in the right hepato-diaphragmatic space, is a safe, economical and simple surgical procedure that is more effective in treating hydrocephalus of various origins than conventional OVPS.
Key words: hydrocephalus, laparoscopy, ventriculoperitoneal shunt (VPS), hepato-diaphragmatic space, distal catheter


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