腹腔镜在脑室腹腔分流术后腹腔并发症处理中的应用

目的:探讨腹腔镜在处理脑积水脑室腹腔分流术后腹部并发症中的作用,及与常规剖腹探查手术相比有何优势。方法:用腹腔镜对常规剖腹安置腹腔分流管术后分流失效的11例患者诊断梗阻原因,发现分流管被大网膜包绕7例、盘曲并粘连于膈肌上2例、包埋于腹腔假性囊肿内2例,在腹腔镜下分离粘连和调整分流管末端使其保持通畅,对于分流管包埋于腹腔假性囊肿内的2例患者,腹腔镜下电灼切开囊壁、吸除囊液,最后切除囊壁。在腹腔镜下证实通畅无阻后,将分流管腹腔端安置固定自制的多孔硅胶套管内,放置于肝膈间隙,固定于膈肌肝面上。结果:术后分流管保持通畅,症状减轻,CT显示脑室较术前缩小,配对计量t检验,P<0.05。结论:该方法与常规手术相比创伤小、恢复快、能观察到的空间大,便于明确梗阻的部位、梗阻原因及分流管固定于膈肌肝面,可确切地观察到调整后的分流管在腹腔内是通畅的。

Application of laparoscope in complications after ventri-peritoneal shunting

Objective: To study the application of laparoscope in dealing with complications after ventricle-peritoneal shunting, and its advantage compared with common operation. Methods: Eleven cases were operated with laparoscope, in which 7 cases end of pipes were revolved by great omentum, and 2 cases' ends adhered to diaphragm, 2 cases' ends embedded in cysts. For the 2 cases whose tube terminal embedded in cysts, we cut and opened the bag wall, and collected hydatid fluid. For all the 11 cases , the shuntpipes were separated from adherence, the end of pipes which were combined with cannula were fixed to diaphragm. Results: All kept unobstructed after operation, and CT showed that the ventricles contract after operation. The pair count t-test showed that P<0.05. Conclusion: Compared with common operation, this method has advantages of small wound, quick recovery, the great space of observation and operation, and it's convenient to look for the position of obstruction, and convenient to fix the pipe end on diaphragm.