Soleman Jehuda, Schneider Christian A, Pfeifle Viktoria A, Zimmermann Peter, Guzman Raphael
Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
World Neurosurg. 2017 Mar;99:656-661. doi: 10.1016/j.wneu.2016.12.075. Epub 2016 Dec 27.
To analyze the safety and feasibility of laparoscopic-assisted ventriculoperitoneal shunt (VPS) insertion in children younger than the age of 1 year and weighing less than 5 kg.
We performed a retrospective review of children receiving laparoscopic-assisted VPS. Patient characteristics, complications, operation and hospitalization time, blood loss, and conversion to the standard approach were noted and analyzed.
Laparoscopic-assisted VPS was performed in 25 children. Mean age was 32 months (range 19 days to 18 years); 16 patients (64%) were younger than the age of 1 year and 10 patients (38%) weighed less than 5 kg at the time of surgery. In all cases laparoscopic insertion was possible without the need to convert to the standard approach. No intraoperative laparoscopy-associated complications occurred. Mean estimated blood volume lost was 4.52%, showing no significant difference between patients younger and older than 1 year. Mean operation time was 75.44 minutes (range 45-121 minutes), and mean hospitalization time was 37.1 days (range 4-142 days, median: 22 days). Patients younger than the age of 1 year showed significant shorter operation time (P < 0.001) and longer hospitalization time (P = 0.04). Complication rate within 30 days was 24% (n = 6), and overall complication rate was 36% (n = 9), whereas none were related to the abdominal placement of the catheter, and showed no difference between the 2 age groups.
Laparoscopic-assisted VPS insertion in children seems to be safe and feasible leading to very good results even in patients under the age of 1 and weighing less than 5 kg.
分析在1岁以下且体重不足5 kg的儿童中进行腹腔镜辅助脑室腹腔分流术（VPS）的安全性和可行性。
我们对接受腹腔镜辅助VPS的儿童进行了回顾性研究。记录并分析了患者特征、并发症、手术及住院时间、失血量以及转为标准手术方式的情况。
对25例儿童实施了腹腔镜辅助VPS。平均年龄为32个月（范围19天至18岁）；16例患者（64%）年龄小于1岁，10例患者（38%）手术时体重不足5 kg。所有病例均可行腹腔镜置入，无需转为标准手术方式。未发生术中与腹腔镜相关的并发症。估计平均失血量为4.52%，1岁以下和1岁以上患者之间无显著差异。平均手术时间为75.44分钟（范围45 - 121分钟），平均住院时间为37.1天（范围4 - 142天，中位数：22天）。1岁以下患者手术时间显著较短（P < 0.001），住院时间较长（P = 0.04）。30天内并发症发生率为24%（n = 6），总体并发症发生率为36%（n = 9），且均与导管腹腔置入无关，两个年龄组之间无差异。
在儿童中进行腹腔镜辅助VPS置入似乎是安全可行的，即使对于1岁以下且体重不足5 kg的患者也能取得很好的效果。
