Dzongowski Emily, Coriolano Kamary, de Ribaupierre Sandrine, Jones Sarah A
Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada.
Department of Paediatrics, Western University, London, ON, Canada.
Childs Nerv Syst. 2017 Dec;33(12):2087-2093. doi: 10.1007/s00381-017-3609-5. Epub 2017 Oct 9.
The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure.
We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified.
Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6).
The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.
本研究旨在通过评估二次分流失败的总发生率，确定引流和修复是否是治疗与脑室腹腔（VP）分流失败相关的腹部假性囊肿的有效方法。
我们对2000年1月1日至2016年5月31日期间在伦敦健康科学中心儿童医院（LHSC）被诊断并接受腹部假性囊肿治疗的脑积水患儿进行了回顾性研究（伦理批准号108136）。纳入标准为：（i）年龄在2至18岁之间确诊为腹部假性囊肿，（ii）通过介入放射学（IR）或手术引流治疗假性囊肿，（iii）对VP分流进行修复。记录人口统计学数据、假性囊肿形成/治疗细节以及随后的失败情况。
12例接受VP分流的患者出现腹部假性囊肿并符合纳入标准。引流和分流修复后分流失败率为91%。3例患者在介入放射学下行假性囊肿引流，后因分流感染而外置。9例患者接受了手术修复。10例患者在假性囊肿初次引流后出现分流反复失败：假性囊肿复发（n = 3）、粘连导致远端梗阻（n = 1）、感染未清除（n = 6）。
结果表明，假性囊肿引流和分流修复在提供分流问题的长期解决方案方面无效。
