CAJ | 학술논문

目的前瞻性探讨脑室-腹腔(V -P)分流术后分流管腹腔端位置的动态变化,确定腹腔端的简单、有效处置方法.方法回顾性总结采用V-P分流术治疗的40例脑积水患者,脑室端均采用额角穿刺,腹腔端采用剑突下4 cm正中切口,腹膜切开3 mm后将分流管腹腔端置入腹腔内.术后第1、3和7天常规复查头颅CT,同时行腹部平片确定腹腔端分流管位置.结果 CT显示40例均分流效果良好.腹部平片显示术后第1天分流管腹腔端位于盆腔31例,下腹腔5例；术后第3天和第7天分流管腹腔端位于盆腔内分别为35和39例.1例术后第5天发生对侧急性硬脑膜下血肿,家属放弃手术自动出院；余患者平均于术后(11±4)d出院.1例术后1年发生腹腔端感染,控制感染后改行脑室-心房(V -A)分流术；余患者术后随访1个月-2年,无相关并发症发生.结论采用剑突下正中小切口,可减少手术创伤并缩短手术时间,获得良好的分流效果；分流管腹腔端处置的方法简单、实用,分流管腹腔端绝大多数在术后1d内降入盆腔内,无需特殊固定和处理.
목적 전첨성탐토뇌실-복강(V -P)분류술후분류관복강단위치적동태변화,학정복강단적간단、유효처치방법.방법 회고성총결채용V-P분류술치료적40례뇌적수환자,뇌실단균채용액각천자,복강단채용검돌하4 cm정중절구,복막절개3 mm후장분류관복강단치입복강내.술후제1、3화7천상규복사두로CT,동시행복부평편학정복강단분류관위치.결과 CT현시40례균분류효과량호.복부평편현시술후제1천분류관복강단위우분강31례,하복강5례；술후제3천화제7천분류관복강단위우분강내분별위35화39례.1례술후제5천발생대측급성경뇌막하혈종,가속방기수술자동출원；여환자평균우술후(11±4)d출원.1례술후1년발생복강단감염,공제감염후개행뇌실-심방(V -A)분류술；여환자술후수방1개월-2년,무상관병발증발생.결론 채용검돌하정중소절구,가감소수술창상병축단수술시간,획득량호적분류효과；분류관복강단처치적방법간단、실용,분류관복강단절대다수재술후1d내강입분강내,무수특수고정화처리.
Objective To investigate the dynamic changes of peritoneal catheter of ventriculoperitoneal shunt (V- P shunt) prospectively,and to determine simple,effective disposal method of peritoneal catheter.Method From Jan 2007 to Oct 2010,consecutive 40 patients with hydrocephalus were treated by V - P shunt.All patients were operated through puncture of frontal horn of lateral ventricle.And 4 cm straight abdominal incision under xiphoid was made and after shunt system had been connected well,the abdominal catheter was put into peritoneal cavity through 3 mm incision of peritoneum.Head CT scans were regularly made at the 1st,3rd and 7th day after shunt to determine the intracranial state for all patients,and abdominal X - ray plain films were also obtained to confirm the position of peritoneal catheters at the same time.All the clinical data and results of follow - up were reviewed.Results Dynamic head CT scans showed good results of V - P shunt after surgery in all cases.And abdominal X -ray plain films at the 1 st day after operation showed peritoneal catheter was located in pelvic cavity in 31 cases and lower abdominal cavity in 5 cases.At the 3rd day and 7th day after operation,the numbers of peritoneal catheter located in pelvic cavity were 35 and 39 respectively.Among these patients,a large acute subdural hematoma occurred on the same side of V - P shunt at the 5th day after operation.This patient was discharged with GCS 6 as his family refused decompressive craniectomy.The remaining 39 patients were discharged with average hospital - stay time of 11 ± 4 days after shunt.On follow - up,1 patient developed peritoneal infection one year later.After the infection was controlled,he was changed to ventriculo- atrial (V -A) shunt.There was no shunt- related complication occurred on the others during 1 -24 month follow - up periods.Conclusion V - P shunt through small straight incision under xiphoid could reduce surgical injury,shorten the operating time and obtain good Results.Dynamic observation of the location of peritoneal catheter by abdominal X - ray plain film is a simple and practical method.The peritoneal catheter will located in pelvic cavity at the 1 st day after shunt in vast majority.There is no special management for peritoneal catheter in V - P shunt in required.