Reardon P R, Scarborough T K, Matthews B D, Marti J L, Preciado A
Department of Surgery, Baylor College of Medicine, Houston, TX 77030 USA.
Surg Endosc. 2000 Jun;14(6):585-6. doi: 10.1007/s004640020078.
Laparoscopy has potential benefit in the placement of ventriculoperitoneal shunts. In patients who have undergone multiple shunt revisions or other abdominal operations, laparoscopy may be particularly beneficial when finding of a suitable area in which to place the shunt is a concern. The purpose of this study was to evaluate the safety and effectiveness of laparoscopically assisted ventriculoperitoneal shunt placement, with an emphasis on using 2-mm instrumentation.
Laparoscopically assisted ventriculoperitoneal shunt placement using 2-mm instrumentation was performed in eight adult hydrocephalus patients from August 1996 to September 1998. All eight patients had undergone 1 to 18 prior shunt revisions. The procedures were performed with two 2-mm trocars. The instrumentation consisted of a 2-mm laparoscope, a 2-mm grasper, and 2-mm scissors. All shunts were placed in an area free of adhesions and checked for flow under direct vision. Four of the patients required a lysis of adhesions to create a space adequate for catheter placement.
All of the procedures were successful, with no operative complications. The operative times ranged from 29 to 99 min, (mean, 63 min). The blood loss in all of the procedures was minimal. At this writing, none of the patients have required subsequent distal shunt revisions. No conversions to larger instruments or an open procedure were required.
Laparoscopically assisted ventriculoperitoneal shunt placement using 2-mm instrumentation is safe and effective, offering several advantages over the open procedure. This procedure is ideal for the use of 2-mm instruments.
腹腔镜检查在脑室腹腔分流术中具有潜在益处。对于接受过多次分流术修订或其他腹部手术的患者，当寻找合适的分流放置区域成为一个问题时，腹腔镜检查可能特别有益。本研究的目的是评估腹腔镜辅助脑室腹腔分流术放置的安全性和有效性，重点是使用2毫米器械。
1996年8月至1998年9月，对8例成年脑积水患者进行了使用2毫米器械的腹腔镜辅助脑室腹腔分流术放置。所有8例患者此前均接受过1至18次分流术修订。手术通过两个2毫米套管针进行。器械包括一个2毫米腹腔镜、一个2毫米抓钳和2毫米剪刀。所有分流管均放置在无粘连的区域，并在直视下检查通畅情况。4例患者需要进行粘连松解以创造足够的空间来放置导管。
所有手术均成功，无手术并发症。手术时间为29至99分钟（平均63分钟）。所有手术的失血量极少。在撰写本文时，没有患者需要进行后续的远端分流术修订。无需更换为更大的器械或转为开放手术。
使用2毫米器械进行腹腔镜辅助脑室腹腔分流术放置是安全有效的，与开放手术相比具有多个优势。该手术非常适合使用2毫米器械。
