腹腔镜下脑室-腹腔分流术治疗小儿脑积水的疗效及安全性分析

目的:探讨腹腔镜下脑室-腹腔分流术(VPS)治疗小儿脑积水的疗效及安全性。方法:脑积水患儿56例依据采取的手术方式分为对照组和腹腔镜组,各28例。腹腔镜组采用腹腔镜下VPS,对照组采用传统VPS。比较2组手术时间、临床症状改善情况(Kamofsky评分)、手术有效率(Salmon标准)、并发症及血清神经元特异性烯醇化酶(NSE)和S-100蛋白含量。结果:腹腔镜组手术时间及术后排气时间明显短于对照组缩短(P0.01);术后2组Kamofsky评分均明显升高(P0.01),且腹腔镜组评分高于对照组(P0.05);腹腔镜组总有效率为85.71%,高于对照组的60.71%(P0.05);腹腔镜组并发症总发生率为10.71%,明显低于对照组的39.29%(P0.05);术前2组血清NSE及S-100蛋白含量差异无统计学意义(P0.05);术后2组NSE及S-100蛋白含量与同组术前差异有统计学意义(P0.01);术后第3天腹腔镜组血清NSE及S-100蛋白含量均低于对照组(P0.05)。结论:腹腔镜下VPS较常规手术方式可明显提高脑积水患儿治疗的有效率,显著减少并发症,是安全、有效的手术方法。

Efficacy and Safety of Laparoscopic Ventriculoperitoneal Shunt in Children withHydrocephalus

To evaluate the efficacy and safety of laparoscopic ventriculoperitoneal shunt (VPS)surgery in children with hydrocephalus. Methods: We included 56 pediatric patients with hydrocephalus intothe study and divided them into the laparoscopy group and control group, with 28 patients per group, accordingto the type of surgery received. The laparoscopy group underwent laparoscopic VPS surgery and the controlgroup received traditional VPS surgery. The duration of surgery, improvement of clinical symptoms (Kamofskyscore), efficacy of surgery (Salmon standard), complications, and serum levels of neuron specific enolase (NSE)and S-100 protein were assessed and compared between the two groups. Results: Compared with the controlgroup, the surgery duration and postoperative exhaust time were significantly shorter in the laparoscopy group(P<0.01). The Kamofsky scores of both groups after surgery were significantly higher than those before surgery(P<0.01), and those of the laparoscopy group were significantly higher than those in the control group (P<0.05).The total effective rate of the laparoscopy group was 85.71% which was significantly higher than the 60.71% ofthe control group (P<0.05). The incidence of complications in the laparoscopy group was 10.71% which waslower than the 39.29% of the control group (P<0.05). There was no significant difference between the two groupsin serum levels of NSE and S-100 protein before surgery (P>0.05). The serum levels of NSE and S-100 proteinin each group after surgery showed a significant difference when compared to the same group before surgery (P<0.01). The serum levels of NSE and S-100 protein in the laparoscopy group 3 days after surgery weresignificantly lower than those of the control group (P<0.05). Conclusion: Compared to traditional VPS surgery,laparoscopic VPS surgery can significantly improve efficacy in the treatment of children with hydrocephalus andreduce the incidence of complications; it is a safe and effective surgical method