Gonzalez Dani O, Cooper Jennifer N, McLeod Daryl J
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Pediatr Rehabil Med. 2017 Dec 11;10(3-4):249-255. doi: 10.3233/PRM-170452.
Most patients with spina bifida require ventriculoperitoneal (VP) shunt placement. Some also require bladder augmentation, which may increase the risk of VP shunt malfunction and/or failure. The aim of this study was to assess whether bladder augmentation affects the rate of VP shunt failure in this population.
Using the Pediatric Health Information System, we studied patients with spina bifida born between 1992 and 2014 who underwent VP shunt placement. Using conditional logistic regression, we compared age- and hospital-matched patients who did and did not undergo a bladder augmentation to determine their difference in rates of VP shunt failure.
There were 4192 patients with spina bifida who underwent both surgical closure and VP shunt placement. Of these, 203 patients with bladder augmentation could be matched to 593 patients without bladder augmentation. VP shunt failure occurred within 2 years in 7.7% of patients, the majority of whom were in the group who underwent bladder augmentation (87%). After adjusting for confounders, undergoing bladder augmentation was independently associated with VP shunt failure (HR: 33.5, 95% CI: 13.15-85.44, p< 0.001).
Bladder augmentation appears to be associated with VP shunt failure. Additional studies are necessary to better define this relationship and identify risk-reduction techniques.
大多数脊柱裂患者需要进行脑室腹腔（VP）分流术。有些患者还需要膀胱扩大术，这可能会增加VP分流器故障和/或失效的风险。本研究的目的是评估膀胱扩大术是否会影响该人群中VP分流器失效的发生率。
利用儿科健康信息系统，我们研究了1992年至2014年间出生且接受VP分流术的脊柱裂患者。我们使用条件逻辑回归，比较了年龄和医院匹配的、接受和未接受膀胱扩大术的患者，以确定他们在VP分流器失效发生率上的差异。
共有4192例脊柱裂患者接受了手术闭合和VP分流术。其中，203例接受膀胱扩大术的患者可与593例未接受膀胱扩大术的患者匹配。7.7%的患者在2年内发生VP分流器失效，其中大多数在接受膀胱扩大术的组中（87%）。在对混杂因素进行调整后，接受膀胱扩大术与VP分流器失效独立相关（风险比：33.5，95%置信区间：13.15 - 85.44，p < 0.001）。
膀胱扩大术似乎与VP分流器失效有关。需要进一步研究以更好地明确这种关系并确定降低风险的技术。
