Department of Obstetrics and Gynecology, Lenox Hill Hospital, New York, New York 10012, USA.
J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):107-9. doi: 10.1016/j.jmig.2009.09.014.
The surgical approach in a patient with a ventriculoperitoneal shunt in need of abdominal surgery remains controversial. The risk of increased intracranial pressure with pneumoperitoneum in laparoscopy is still unresolved. We used the LapDisc (Ethicon, Inc., Somerville, New Jersey) to access the shunt and temporarily seal it, which enabled us to perform laparoscopic resection of endometriosis without subjecting the shunt to high intraabdominal pressure. The benefits of this approach are the ability to perform laparoscopy, less skin-to-shunt contact minimizing infection, and elimination of possible increased intracranial pressure secondary to pneumoperitoneum. With the progress made in the management of hydrocephalus, patients with ventriculoperitoneal (VP) shunts enjoy a longer lifespan. Therefore, the gynecologic laparoscopic surgeon can expect to treat a patient with a VP shunt in place.
对于需要腹部手术的脑室-腹腔分流术患者，手术入路仍存在争议。气腹腹腔镜手术中颅内压升高的风险仍未解决。我们使用 LapDisc（Ethicon，Inc.，Somerville，新泽西州）来进入分流管并暂时封闭它，这使我们能够在不使分流管承受高腹腔内压力的情况下进行腹腔镜子宫内膜异位症切除术。这种方法的优点是能够进行腹腔镜手术，减少皮肤与分流管的接触以最大程度地减少感染，并消除可能因气腹引起的颅内压升高。随着脑积水管理的进展，脑室-腹腔（VP）分流术患者的寿命更长。因此，妇科腹腔镜外科医生可以预期治疗一个带有 VP 分流管的患者。
