Aldana Philipp R, James Hector E, Postlethwait Richard A
Department of Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida, USA.
J Neurosurg Pediatr. 2008 Apr;1(4):284-7. doi: 10.3171/PED/2008/1/5/284.
The authors report a clinical protocol for the application of ventriculogallbladder (VGB) shunts in children who may be unable to maintain or receive ventriculoperitoneal (VP) shunts.
Eighteen patients underwent placement of VGB shunts as an alternative to VP shunt therapy for the following reasons: malfunction of the VP shunt due to suspected failure of the peritoneum to absorb cerebrospinal fluid (17 cases) and multiple intraabdominal general surgical procedures (1 case). The patients ranged in age from 4 months to 17 years (mean 6.5 +/- 6.1 years [standard deviation {SD}]). All patients underwent preoperative imaging of the gall-bladder either by ultrasonography or computed tomography scanning. A team consisting of a pediatric neurological surgeon and a pediatric general surgeon performed all operative procedures. The procedures were conducted by open laparotomy to precisely place the appropriate length of distal catheter and to anchor it to the gallbladder wall.
There were 2 early shunt malfunctions, both obstructions due to "sludge" (1 in the biliary duct and 1 in the common bile duct). A late-onset (5-year) malfunction occurred secondary to gallbladder stones. In all 3 cases of malfunction, the devices were successfully converted to VP shunts. In 1 patient a conversion to a VP shunt was chosen following a general surgical intervention. There were 2 shunt infections (Staphylococcus epidermidis and Haemophilus influenzae). These were successfully treated. Two patients underwent conversion to a VGB shunt on 2 occasions. Thirteen patients had functional VGB shunts at the time of their last follow-up assessment. The follow-up for these 13 patients ranged from 1 to 8 years (mean 2.1 +/- 2.0 years [SD]).
Ventriculogallbladder shunts may be considered for the treatment of hydrocephalus in children when the peritoneal cavity cannot be used as a distal terminus.
作者报告了一种用于可能无法维持或接受脑室腹腔（VP）分流术的儿童的脑室胆囊（VGB）分流术的临床方案。
18例患者因以下原因接受VGB分流术以替代VP分流术治疗：怀疑腹膜吸收脑脊液失败导致VP分流器故障（17例）和多次腹部普通外科手术（1例）。患者年龄从4个月至17岁不等（平均6.5±6.1岁[标准差{SD}]）。所有患者术前均通过超声或计算机断层扫描对胆囊进行成像。由一名小儿神经外科医生和一名小儿普通外科医生组成的团队进行了所有手术操作。手术通过开放剖腹术进行，以精确放置合适长度的远端导管并将其固定在胆囊壁上。
有2例早期分流器故障，均为因“淤泥”导致的阻塞（1例在胆管，1例在胆总管）。1例晚期（5年）故障继发于胆囊结石。在所有3例故障中，装置均成功转换为VP分流器。1例患者在进行普通外科干预后选择转换为VP分流器。有2例分流器感染（表皮葡萄球菌和流感嗜血杆菌）。这些均得到成功治疗。2例患者分两次转换为VGB分流器。13例患者在最后一次随访评估时VGB分流器功能正常。这13例患者的随访时间为1至8年（平均2.1±2.0年[SD]）。
当腹腔不能用作远端终点时，可考虑采用脑室胆囊分流术治疗儿童脑积水。
