腹腔镜辅助下治疗脑积水

目的探讨比较腹腔镜辅助下的脑室-腹腔(V-P)分流术与传统文献报道的V-P分流术的手术疗效。方法本组23例，梗阻性脑积水16例，交通性脑积水7例。19例颅内压高于正常。均行V-P分流术。将分流管的脑室端置入侧脑室的额角，分流泵置于耳后。腹腔端置管时，在腹腔镜的辅助下，于剑突下进入腹腔，并用一穿刺针带7号丝线，在右腋中、腋后线第八肋间刺入腹腔，将7号丝线带入腹腔，并固定于肝膈面。结果23例均行随访3～35个月．平均18个月。术后1周、1个月及3个月行头颅CT检查，脑室缩小至正常20例，2例好转，1例引流过度呈裂隙状。行腹部X线平片检查，所有病例引流管均在肝膈面。23例均无引流管阻塞发生，无颅内感染及腹腔感染。4例脑肿瘤患者术后9～13月死亡。结论腹腔镜辅助下的侧脑室-肝隔间隙分流术治疗脑积水，与传统的常规V-P分流术比较，具有切口小、创伤轻、恢复快的特点，人工气腹使肝隔间隙显露良好、视野大而开阔、手术操作空问大、使分流管末端粘连及阻塞的可能性明显减少。

Laparoscope-assited treatment of hydrocephalus

Objective To compare the effect of ventriculo-peritoneal shunt assited with laparoscope to that of conventional ventriculo-penitoneal shunt reported in literature. Methods Among the all 23 cases (16 obstractive hydrocephalus, 7 communicating hydrocephalus), 19 had higher intracranial pressure. The ventricular catheter was inserted into the anterior horn of lateral ventricle. The valve was placed under the shin flap behind the ear, while the peritoneal catheter was inserted into the abdominal cavity just below the ensirorm process under laparoscope. A 7-typed thread was introduced into the abdominal cavity in the eighth intercostals space at the right midaxillary line by a puncture needle and then fixed on the diaphragm at liver surface. Results Follow-up was made in 23 cases for 3-35 months (averaged 18 months) after operation. 4 cases of brain tumor diedin 9-13 months after operation. 20 cases recovered to normal ventrides in the CT image 1 week, 1 month and 3 months after operation, respectively, and 2 cases appeared with improvement, and 1 case appeared slit by over-drainage. No shunt obstraction, no intracranid infection and intraperitoneal infection occurred in all the 23 cases. X-ray examination showed the catheters were right located at hepato-diaphragm. Conclusion The lateral ventriculo-hepatodiaphragm shunt with assistance of laparoscope, compared with the classical conventional ventriculo-peritoneal shunt, has many advantages such as smaller incision, less damage, faster recovery, better exposure of hepato-diaphragm with pneumoperitoneum, larger field for operation and obviously less possibility of adhesion and obstruction of catheter terminals.