Hayashi Yutaka, Okazaki Tadaharu, Kobayashi Hiroyuki, Lane Geoffrey J, Yamataka Atsuyuki
Department of Paediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Asian J Surg. 2008 Oct;31(4):207-10. doi: 10.1016/S1015-9584(08)60088-3.
We report our experience of shunt infections (SIs) following intestinal cystoplasty (CP) in patients with neurogenic bladder (NB) and hydrocephalus.
We reviewed 34 patients with NB who underwent intestinal CP between 1984 and 2005. All had ventriculoperitoneal (VP) shunts converted to ventriculopleural (VL) shunts prior to intestinal CP to prevent SIs. SI secondary to intestinal CP was defined as infection within 30 days of intestinal CP.
No SIs were reported. Mean age at shunt conversion was 9.5 years (range, 2-25 years), mean length of follow-up after conversion was 12.8 years (range, 2-18 years), and mean period between conversion and CP was 12 days (range, 0-30 days). Pleural effusion (PE) occurred post-conversion in 13/34 subjects (41%). Ten were treated with diuretics for a mean of 12 days, two were treated conservatively, and one required revision to a ventriculoatrial shunt. Delayed PE occurred in two patients at 7 and 18 months, secondary to respiratory infections. In the literature, there are six reports of SIs after intestinal CP in 216 NB patients. Overall, seven of 216 patients (3.2%) had SI.
VP shunts should be converted to VL shunts prior to intestinal CP because this appears to prevent SIs.
我们报告神经源性膀胱（NB）合并脑积水患者行肠道膀胱扩大术（CP）后发生分流感染（SI）的经验。
我们回顾了1984年至2005年间接受肠道CP的34例NB患者。所有患者在肠道CP前均将脑室腹腔（VP）分流转换为脑室胸膜（VL）分流，以预防SI。肠道CP继发的SI定义为肠道CP后30天内发生的感染。
未报告SI。分流转换时的平均年龄为9.5岁（范围2 - 25岁），转换后的平均随访时间为12.8年（范围2 - 18年），转换与CP之间的平均间隔时间为12天（范围0 - 30天）。13/34例（41%）患者转换后出现胸腔积液（PE）。10例患者接受利尿剂治疗，平均治疗12天，2例保守治疗，1例需要改为脑室心房分流。2例患者在7个月和18个月时因呼吸道感染继发延迟性PE。文献中，有6篇关于216例NB患者肠道CP后发生SI的报告。总体而言，216例患者中有7例（3.2%）发生SI。
肠道CP前应将VP分流转换为VL分流，因为这似乎可预防SI。
