Hayashi T, Hashimoto T, Fukuda S, Anegawa S, Torigoe R
Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan.
No To Shinkei. 1990 Nov;42(11):1049-54.
Although ventriculoperitoneal (V-P) shunt is common as the surgical procedure for hydrocephalus, mechanical malfunction and infection are the most significant problems. Despite the current use of variety of mechanical shunting systems, shunt malfunction remains a major problem in pediatric neurosurgical practice. Pathological lesions associated with malfunctioning shunts have been studied only infrequently. From April 1980 to December 1987, we experienced 96 cases of V-P shunt in neonates and suckling. The therapeutic results of shunting and causes of initial shunt revision in those cases with nontumoral hydrocephalus were studied. Of 96 cases, which included 55 cases of congenital and 41 cases of acquired hydrocephalus, in which a V-P shunt had been performed, those cases with no history of shunt revision or with only elective shunt revision during the 5-year follow-up period were classified as successful shunt. The 56 of 96 cases (58.3% successful shunts included 15 of 24 patients with myelomeningocele, 7 of 10 with encephalocele, 12 of 21 with various types of cerebral anomaly, 12 of 22 with posthemorrhagic hydrocephalus and 10 with postmeningitic hydrocephalus. There were 12 successful shunts performed in 27 premature and 44 in 69 mature infants. The 40 patients (41.7% with non-elective shunt revision included 5 with breakdown of the sutured scalp with cerebrospinal fluid leakage, 20 with obstruction of the shunt system (14 ventricular side, 6 abdominal side, and 15 with infection. During the 5-year follow-up period 11 died and 85 survived 88.5%), of whom 43 (44.8%) showed normal intellectual development and 42 (43.7%) showed developmental disability.
尽管脑室腹腔（V-P）分流术是治疗脑积水的常见外科手术，但机械故障和感染是最严重的问题。尽管目前使用了各种机械分流系统，但分流故障仍是小儿神经外科实践中的一个主要问题。与分流故障相关的病理病变很少被研究。1980年4月至1987年12月，我们诊治了96例新生儿和婴儿的V-P分流术病例。对那些非肿瘤性脑积水病例的分流治疗结果及初次分流修正的原因进行了研究。96例病例中，包括55例先天性脑积水和41例后天性脑积水，均进行了V-P分流术，那些在5年随访期内无分流修正史或仅进行选择性分流修正的病例被归类为分流成功。96例中的56例（58.3%）分流成功，包括24例脊髓脊膜膨出患者中的15例、10例脑膨出患者中的7例、21例各种类型脑畸形患者中的12例、22例出血后脑积水患者中的12例和22例脑膜炎后脑积水患者中的10例。27例早产儿中有12例分流成功，69例成熟婴儿中有44例分流成功。40例（41.7%）进行了非选择性分流修正，包括5例头皮缝合处破裂伴脑脊液漏、20例分流系统梗阻（脑室端14例；腹腔端（腹腔端）6例）和15例感染。在5年随访期内，11例死亡，85例存活（88.5%），其中43例（44.8%）智力发育正常，42例（43.7%）有发育障碍。
