脑积水分流术腹穿置管的临床应用研究

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

Clinical study on via atrocar introducing the distal catheter of shunt into peritoneal cavity

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.