Ghritlaharey Rajendra K, Budhwani Keshav S, Shrivastava Dhirendra K, Srivastava Jyoti
Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals Bhopal, Madhya Pradesh, India.
Afr J Paediatr Surg. 2012 Jan-Apr;9(1):32-9. doi: 10.4103/0189-6725.93300.
The aim of this study was to review the management of ventriculoperitoneal (VP) shunt complications in children.
During the last 5 years (January 1, 2006 to December 31, 2010), 236 VP shunt operations were performed in children under 12 years of age; of these, 40 (16.94%) developed shunt complications and those who underwent VP shunt revisions were studied.
This prospective study included 40 (28 boys and 12 girls) children and required 48 shunt revisions. Complications following VP shunts that required shunt revisions were peritoneal catheter/peritoneal end malfunction (18), shunt/shunt tract infections (7), extrusion of peritoneal catheter through anus (5), ventricular catheter malfunction (4), cerebrospinal fluid (CSF) leak from abdominal wound (4), shunt system failure (2), ventricular end/shunt displacement (2), CSF pseudocysts peritoneal cavity (2), extrusion of peritoneal catheter from neck, chest, abdominal scar and through umbilicus, one each. Four-fifth of these shunt complications occurred within 6 months of previous surgery. Surgical procedures done during shunt revisions in order of frequency were revision of peritoneal part of shunt (27, 56.25%), revision of entire shunt system (6, 12.5%), extra ventricular drainage and delayed re-shunt (5, 10.41%), shunt removal and delayed re-shunt (5, 10.41%), opposite side shunting (2, 4.16%), cysts excision and revision of peritoneal catheter (2, 4.16%) and revision of ventricular catheter (1, 2.08%). The mortalities following VP shunt operations were 44 (18.64%) and following shunt revisions were 4 (10%).
VP shunt done for hydrocephalus in children is not only prone for complications and need for revision surgery but also associated with considerable mortality.
本研究的目的是回顾儿童脑室腹腔（VP）分流术并发症的处理。
在过去5年（2006年1月1日至2010年12月31日）期间，对12岁以下儿童进行了236例VP分流手术；其中40例（16.94%）出现分流并发症，并对接受VP分流术翻修的患儿进行了研究。
这项前瞻性研究纳入了40例儿童（28例男孩和12例女孩），需要进行48次分流术翻修。需要进行分流术翻修的VP分流术后并发症包括腹腔导管/腹腔端故障（18例）、分流/分流道感染（7例）、腹腔导管经肛门挤出（5例）、脑室导管故障（4例）、腹部伤口脑脊液（CSF）漏（4例）、分流系统故障（2例）、脑室端/分流移位（2例）、CSF假性囊肿腹腔（2例）、腹腔导管从颈部、胸部、腹部瘢痕及经脐部挤出，各1例。这些分流并发症的五分之四发生在前次手术的6个月内。分流术翻修时按频率依次进行的手术操作有分流腹腔部分翻修（27例，56.25%）、整个分流系统翻修（6例，12.5%）、脑室外引流及延迟再分流（5例，10.41%）、分流移除及延迟再分流（5例，10.41%）、对侧分流（2例，4.16%）、囊肿切除及腹腔导管翻修（2例，4.16%）和脑室导管翻修（1例，2.08%）。VP分流术后死亡率为44例（18.64%），分流术翻修后死亡率为4例（10%）。
儿童脑积水行VP分流术不仅容易出现并发症且需要翻修手术，还伴有相当高的死亡率。
