Choux M, Genitori L, Lang D, Lena G
Department of Pediatric Neurosurgery, Hôpital des Enfants, La Timone, Marseille, France.
J Neurosurg. 1992 Dec;77(6):875-80. doi: 10.3171/jns.1992.77.6.0875.
Shunt infection remains the foremost problem of shunt implantation after mechanical malfunctions. Diversionary cerebrospinal fluid shunt implantation has a high complication rate, with 5% to 15% of such shunts becoming infected. Of these infections, 70% are diagnosed within 1 month after surgery and more than 90% within 6 months. Shunt infection in the vast majority of cases is therefore a complication of shunt surgery. The authors review their experience with shunt implantation during two time periods. From January, 1978, to December, 1982, 302 children with hydrocephalus underwent 606 operations. Among these children, 47 (15.56%) developed a proven shunt infection, with an incidence of infection per procedure of 7.75%. As a result of this study, a new protocol for shunt procedures involving modifications in the immediate pre-, intra-, and postoperative management of children undergoing shunt implantation was initiated. With this new protocol, 600 children underwent a total of 1197 procedures between January, 1983, and December, 1990. The incidence of shunt infection decreased dramatically, with two infections (0.33%) in 600 patients and a per-procedure rate of 0.17%. The overall annual risk of a shunt infection in the pediatric neurosurgical unit is currently 1.04%.
分流感染仍然是机械故障后分流植入的首要问题。脑脊液分流植入术的并发症发生率很高，5%至15%的此类分流会发生感染。在这些感染中，70%在术后1个月内被诊断出来，90%以上在6个月内被诊断出来。因此，绝大多数情况下的分流感染是分流手术的并发症。作者回顾了他们在两个时间段内进行分流植入的经验。从1978年1月到1982年12月，302例脑积水患儿接受了606次手术。在这些患儿中，47例（15.56%）发生了经证实的分流感染，每次手术的感染发生率为7.75%。这项研究的结果是，启动了一项新的分流手术方案，该方案涉及对接受分流植入术患儿的术前、术中和术后即时管理进行调整。采用这个新方案，在1983年1月至1990年12月期间，600例患儿共接受了1197次手术。分流感染的发生率大幅下降，600例患者中有2例感染（0.33%），每次手术的感染率为0.17%。目前，儿科神经外科病房分流感染的总体年度风险为1.04%。
