CAJ | 학술논문

目的通过随机对照临床应用研究，对脑积水脑室－腹腔分流术术式改进前后临床效果作出评价，确立一种手术方法并探讨减少并发症的途径。方法确诊脑积水且需行脑室－腹腔分流术，术中采取右上腹腹直肌旁切口或腹穿针打通腹壁全层两种方式中之一置分流管于腹腔内，常规脑室端、皮下置管。结果两种术式比较疗效差异无显著性，前者术式术后腹部不适反应持续时间长；后者手术过程简便、时间短、术后腹部不适反应持续时间短，但后者术式有3个腹腔端分流管位于腹膜外未进入腹腔，术后出现皮下积液，其中2例脑脊液切口漏，另1例右胸局部皮肤感染，皆经修正手术治愈出院。结论改进后的脑室－腹腔分流术术式临床应用中可以人为采取措施减少并发症，术式先进，值得推广。
목적통과수궤대조림상응용연구，대뇌적수뇌실－복강분류술술식개진전후림상효과작출평개，학립일충수술방법병탐토감소병발증적도경。방법학진뇌적수차수행뇌실－복강분류술，술중채취우상복복직기방절구혹복천침타통복벽전층량충방식중지일치분류관우복강내，상규뇌실단、피하치관。결과량충술식비교료효차이무현저성，전자술식술후복부불괄반응지속시간장；후자수술과정간편、시간단、술후복부불괄반응지속시간단，단후자술식유3개복강단분류관위우복막외미진입복강，술후출현피하적액，기중2례뇌척액절구루，령1례우흉국부피부감염，개경수정수술치유출원。결론개진후적뇌실－복강분류술술식림상응용중가이인위채취조시감소병발증，술식선진，치득추엄。
Objective　Evaluating the outcomes of both conventional and modified operative procedures of shunt by random contrast clinical test,establish a better surgical method and reduce complications.Methods　While cases were diagnosed as hydrocephalus and needed shunting,implant the distal catheter into peritoneal cavity through right upper abdominal lateral rectus incision or via a trocar introduce the catheter.Results　The former groups′ patients had an abdominal unwellness for rather a long term after operation,but the latter had a short-term unwellness postoperatively.Three cases of the latter groups had their distal catheters remained in the abdominal wall,and subcutaneous dropsy was found;two of the three had CSF leak from abdominal incision,other one got a local dermal infection in the right chest.They all were cured and discharged.The latter procedure was simple,brief and less postoperative adverse effects compared with the former.Conclusion　Modified surgical procedure of ventriculo-peritoneal shunt is clinically feasible,more advanced,and safe;surgeons can take measures to reduce complications on their own initiative.The method is worth paying more attention and spreading widely.