Fraser Jason D, Aguayo Pablo, Sharp Susan W, Holcomb III George W, Ostlie Daniel J, St Peter Shawn D
Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri, USA.
J Laparoendosc Adv Surg Tech A. 2009 Oct;19(5):675-8. doi: 10.1089/lap.2009.0116.
In pediatric patients requiring abdominal operations, ventriculoperitoneal (VP) shunts for hydrocephalus are a frequently encountered comorbidity. Laparoscopy has not been extensively evaluated in this population, and there are concerns about the safety of insufflation under pressure with the shunt in place. There are a paucity of data in the literature to address this issue. Further, there is a relative lack of long-term follow-up in the literature to document shunt function over time after abdominal procedures. Therefore, we reviewed our experience in patients with VP shunts who underwent either open or laparoscopic abdominal procedures to determine the safety of laparoscopy in these patients.
We conducted a retrospective review of all pediatric patients with VP shunts who underwent laparoscopic and/or open abdominal operations at a single institution from 1998 to 2008. Complications were defined as a shunt- or surgery-related event (including any shunt revisions) within 6 months of abdominal surgery. Continuous variables were compared by using an independent sampled, two-tailed Student's t-test. Discrete variables were analyzed with Fisher's exact test with Yates correction, where appropriate. Significance was defined as P < or = 0.05.
A total of 99 intra-abdominal operations were performed on patients with VP shunts: 51 were laparoscopic and 48 were open. Mean age was 3.17 versus 2.93 years, respectively (P = 0.77). The most common procedure performed in both groups was fundoplication with gastrostomy. There were no episodes of air embolism into the shunt. There was 1 shunt infection in the laparoscopic group and 3 in the open group (P = 0.56).
Our data suggest that laparoscopy is safe in patients with ventriculoperitoneal shunts.
在需要进行腹部手术的儿科患者中，脑积水的脑室腹腔（VP）分流术是一种常见的合并症。腹腔镜检查在这一人群中尚未得到广泛评估，人们担心在分流管在位的情况下进行加压充气的安全性。文献中缺乏解决这一问题的数据。此外，文献中相对缺乏长期随访以记录腹部手术后分流功能随时间的变化。因此，我们回顾了我们在接受开放或腹腔镜腹部手术的VP分流患者中的经验，以确定腹腔镜检查在这些患者中的安全性。
我们对1998年至2008年在单一机构接受腹腔镜和/或开放腹部手术的所有患有VP分流的儿科患者进行了回顾性研究。并发症定义为腹部手术后6个月内与分流或手术相关的事件（包括任何分流管修订）。连续变量采用独立样本双尾Student t检验进行比较。离散变量在适当情况下采用经Yates校正的Fisher精确检验进行分析。显著性定义为P≤0.05。
对患有VP分流的患者共进行了99例腹腔内手术：51例为腹腔镜手术，48例为开放手术。平均年龄分别为3.17岁和2.93岁（P = 0.77）。两组中最常见的手术是胃底折叠术加胃造口术。没有发生空气进入分流管的情况。腹腔镜组有1例分流管感染，开放组有3例（P = 0.56）。
我们的数据表明，腹腔镜检查对脑室腹腔分流患者是安全的。
