Burks Joshua D, Conner Andrew K, Briggs Robert G, Glenn Chad A, Bonney Phillip A, Cheema Ahmed A, Chen Sixia, Gross Naina L, Mapstone Timothy B
Departments of 1 Neurosurgery and.
Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Neurosurg Pediatr. 2017 May;19(5):571-577. doi: 10.3171/2016.10.PEDS16377. Epub 2017 Feb 17.
OBJECTIVE Experience has led us to suspect an association between shunt malfunction and recent abdominal surgery, yet information about this potential relationship has not been explored in the literature. The authors compared shunt survival in patients who underwent abdominal surgery to shunt survival in our general pediatric shunt population to determine whether such a relationship exists. METHODS The authors performed a retrospective review of all cases in which pediatric patients underwent ventriculoperitoneal shunt operations at their institution during a 7-year period. Survival time in shunt operations that followed abdominal surgery was compared with survival time of shunt operations in patients with no history of abdominal surgery. Univariate and multivariate analyses were used to identify factors associated with failure. RESULTS A total of 141 patients who underwent 468 shunt operations during the period of study were included; 107 of these 141 patients had no history of abdominal surgery and 34 had undergone a shunt operation after abdominal surgery. Shunt surgery performed more than 2 weeks after abdominal surgery was not associated with time to shunt failure (p = 0.86). Shunt surgery performed within 2 weeks after abdominal surgery was associated with time to failure (adjusted HR 3.6, 95% CI 1.3-9.6). CONCLUSIONS Undergoing shunt surgery shortly after abdominal surgery appears to be associated with shorter shunt survival. When possible, some patients may benefit from shunt placement utilizing alternative termini.
目的 经验使我们怀疑分流器故障与近期腹部手术之间存在关联，但关于这种潜在关系的信息在文献中尚未得到探讨。作者将接受腹部手术患者的分流器存活情况与我们普通儿科分流器患者群体的分流器存活情况进行比较，以确定是否存在这种关系。方法 作者对7年间在其机构接受脑室腹腔分流手术的所有儿科患者病例进行了回顾性研究。将腹部手术后进行的分流手术的存活时间与无腹部手术史患者的分流手术存活时间进行比较。采用单因素和多因素分析来确定与失败相关的因素。结果 在研究期间，共有141例患者接受了468次分流手术；这141例患者中，107例无腹部手术史，34例在腹部手术后接受了分流手术。腹部手术后2周以上进行的分流手术与分流器失败时间无关（p = 0.86）。腹部手术后2周内进行的分流手术与失败时间有关（调整后的风险比3.6，95%可信区间1.3 - 9.6）。结论 腹部手术后不久进行分流手术似乎与分流器存活时间较短有关。如果可能的话，一些患者可能会受益于使用替代末端进行分流器置入。
