Kofoed Månsson Philip, Johansson Sofia, Ziebell Morten, Juhler Marianne
Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
BMJ Open. 2017 Jan 16;7(1):e013389. doi: 10.1136/bmjopen-2016-013389.
The objective of this study is to review our experience of shunt surgery by investigating 40 years of development in terms of rates of revision and infection, shunt survival and risk factors.
Medical records and operative reports were reviewed retrospectively for all patients who underwent primary shunt surgery at our department in the years 2010 to 2012. All results were compared with a previous study from our department. A mixed population consisting of 434 patients was included. Adults (≥15 years) accounted for 89.9% of all patients and the mean follow-up time was 1.71 years.
Overall, 42.6% had a revision of which 65.4% fell within 6 months postoperatively. Low age, high-risk diagnoses and less severe brain injury were associated with a higher risk of revision. One and 5-year shunt survival probabilities were 66.2% (61.5-70.9) and 48.0% (41.1-54.9). Within 4 weeks postoperatively, 3.2% had an infection and overall infection rate was 5.5%. Short duration of surgery and the use of antibiotic prophylaxis were associated with a lower risk of infection. The most frequent causes of revision were valve defects (18.4%) and proximal defects or obstructions (15.7%). Compared to the previous study, no convincing improvement was found with regard to the revision rate (42.6% vs 48.3%, p 0.060) or overall infection rate (5.5% vs 7.4%, p 0.261).
Regardless of changes in patient demographics, techniques and equipment, risk of revision and infection still constitutes a major challenge in shunt surgery. The absence of convincing improvements calls for more studies concerning strategies to reduce complications.
本研究的目的是通过调查40年分流手术在翻修率、感染率、分流管生存率及危险因素方面的发展情况，来回顾我们的经验。
对2010年至2012年在我科接受初次分流手术的所有患者的病历和手术报告进行回顾性分析。所有结果与我科之前的一项研究进行比较。纳入了434例患者的混合人群。成人（≥15岁）占所有患者的89.9%，平均随访时间为1.71年。
总体而言，42.6%的患者进行了翻修，其中65.4%在术后6个月内进行。年龄小、高危诊断及脑损伤较轻与翻修风险较高相关。1年和5年分流管生存率分别为66.2%（61.5 - 70.9）和48.0%（41.1 - 54.9）。术后4周内，3.2%的患者发生感染，总体感染率为5.5%。手术时间短和使用抗生素预防与感染风险较低相关。最常见的翻修原因是瓣膜缺陷（18.4%）和近端缺陷或梗阻（15.7%）。与之前的研究相比，在翻修率（42.6%对48.3%，p = 0.060）或总体感染率（5.5%对7.4%，p = 0.261）方面未发现明显改善。
无论患者人口统计学、技术和设备如何变化，翻修和感染风险仍是分流手术的主要挑战。缺乏明显改善需要更多关于降低并发症策略的研究。
