Yu Sherman, Bensard Denis D, Partrick David A, Petty John K, Karrer Frederick M, Hendrickson Richard J
Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Science Center, Denver, Colorado 80218, USA.
JSLS. 2006 Jan-Mar;10(1):122-5.
Ventriculoperitoneal shunt is the preferred treatment for hydrocephalus. Known complications include infection, obstruction, and disconnection with the fractured fragment migrating in the peritoneal cavity. We report 17 cases of laparoscopic evaluation and revision of ventriculoperitoneal shunts in children.
From January 2000 through October 2002, we retrospectively reviewed our experience with laparoscopy and ventriculoperitoneal shunts.
Laparoscopy was performed in 17 children with a malfunctioning shunt, presumed shunt dislodgment or disconnection, reinsertion of a shunt after externalization, and primary shunt placement. Six patients (35%) were converted to an open laparotomy due to dense adhesions. Eleven patients (65%) underwent successful laparoscopic-assisted ventriculoperitoneal shunt placement: 5/11 (45%) had lysis of adhesions or pseudocyst marsupialization with repositioning of a functional shunt, or both; 3/11 (27%) had successful retrieval of a disconnected catheter with reinsertion of a new catheter; 2/11 (18%) had laparoscopic confirmation of satisfactory placement and function, requiring no revision; 1/11 (9%) had an initial shunt placed with laparoscopic guidance due to the obesity. Operative time for the laparoscopic procedure ranged from 30 minutes to 60 minutes. All laparoscopic procedures used 1-mm or two 5-mm ports. Perioperatively, no adverse neurological sequelae occurred due to the pneumoperitoneum.
Laparoscopic guidance or revision of ventriculoperitoneal shunts permits (1) direct visualization of catheter insertion within the peritoneal cavity, (2) satisfactory positioning, (3) lysis of adhesions or marsupialization with catheter repositioning, or both, and (4) retrieval of fractured catheters.
脑室腹腔分流术是脑积水的首选治疗方法。已知的并发症包括感染、梗阻以及分流管断裂碎片在腹腔内移位。我们报告17例儿童脑室腹腔分流术的腹腔镜评估及修复病例。
回顾2000年1月至2002年10月间我们应用腹腔镜及脑室腹腔分流术的经验。
17例分流功能障碍、推测分流管移位或断裂、外置后重新置入分流管以及初次分流管置入的患儿接受了腹腔镜手术。6例（35%）因粘连致密转为开腹手术。11例（65%）成功接受了腹腔镜辅助脑室腹腔分流管置入术：5/11（45%）进行了粘连松解或假性囊肿开窗引流并重新放置功能正常的分流管，或两者皆做；3/11（27%）成功取出断裂的导管并重新置入新导管；2/11（18%）经腹腔镜确认分流管放置及功能满意，无需修复；1/11（9%）因肥胖在腹腔镜引导下初次置入分流管。腹腔镜手术时间为30分钟至60分钟。所有腹腔镜手术均使用1毫米或两个5毫米的端口。围手术期，未因气腹出现不良神经后遗症。
腹腔镜引导或修复脑室腹腔分流术可实现：（1）直接观察分流管在腹腔内的置入情况；（2）满意的定位；（3）粘连松解或开窗引流并重新放置分流管，或两者皆做；（4）取出断裂的导管。
