Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
World Neurosurg. 2021 Aug;152:180-188.e1. doi: 10.1016/j.wneu.2021.05.044. Epub 2021 May 24.
A subset of patients with neurologic deficits require ventriculoperitoneal shunt (VPS) placement in addition to gastrostomy tubes (GTs). At present, the literature is inconsistent with respect to the sequence and time period between procedures that yields the lowest risk profile for GT and VPS placement. The purpose of this systematic literature review was to determine if time elapsed between VPS and GT placement was associated with infection (peritoneal and/or CSF). A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. PubMEd/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases were queried. Precise search terminology is available in the body of the manuscript. The initial database query yielded 88 unique articles. After abstract screening, 28 articles were identified and 6 met criteria for inclusion in the final analysis. The included studies were all retrospective analyses and reported data for 217 patients between the years of 1988 and 2016. Across all included studies, the infection rate after VPS and GT placement during the studies' surveillance period was 15.2% (n = 33/217). The cumulative rate of all reported complications in patients with both VPS and GT was 24.0% (n = 52/217). These studies suggest that placement of GT in patients with preexisting VPS does not significantly contribute to increased shunt or intraperitoneal infection. Future studies should determine the optimal time interval between VPS and GT placement and to identify the most appropriate prophylactic antibiotic regimen.
一部分有神经功能缺损的患者需要脑室-腹腔分流术（VPS）和胃造口管（GT）联合治疗。目前，文献对于这两种治疗方法的先后顺序和时间间隔的报道并不一致，无法确定哪种方案能将风险降到最低。本系统文献回顾的目的是确定 VPS 和 GT 放置之间的时间间隔是否与感染（腹腔和/或 CSF）有关。本系统文献回顾按照 2009 年系统评价和荟萃分析的首选报告项目进行。检索了 PubMEd/MEDLINE、Scopus、Ovid、Cochrane 和 EMBASE 数据库。详细的搜索术语见正文。最初的数据库查询产生了 88 篇独特的文章。经过摘要筛选，确定了 28 篇文章，其中 6 篇符合最终分析的纳入标准。纳入的研究均为回顾性分析，报道了 1988 年至 2016 年间 217 例患者的数据。在所有纳入的研究中，研究监测期间 VPS 和 GT 放置后的感染率为 15.2%（n=33/217）。同时患有 VPS 和 GT 的患者所有报告并发症的累积发生率为 24.0%（n=52/217）。这些研究表明，在已有 VPS 的患者中放置 GT 并不会显著增加分流或腹腔内感染的风险。未来的研究应确定 VPS 和 GT 放置之间的最佳时间间隔，并确定最合适的预防性抗生素方案。
