动态腹部平片能对脑室腹腔分流术后因腹部粘连导致的分流管功能延迟障碍进行简单有效的诊断。

Dynamic plain abdominal film provides simple and effective diagnosis of delayed shunt insufficiency caused by abdominal adhesions after VP shunt.

作者信息

Liu Zhiqiang, Chen Jintao, Weng Chaoqun, Liu Bei, Lin Zhixiong

机构信息

Department of Neurosurgery, Fujian Sanbo Funeng Brain Hospital, Fuzhou, Fujian, China.

Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Xiangshanyikesong 50#, HaiDian District, Beijing, China.

出版信息

Chin Neurosurg J. 2024 Sep 3;10(1):26. doi: 10.1186/s41016-024-00378-z.

DOI:10.1186/s41016-024-00378-z

PMID:39228004

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11370078/

Abstract

BACKGROUND

Many complications may occur after placement of the ventriculoperitoneal shunt (VP shunt) for hydrocephalus, and delayed shunt insufficiency (DSI) is among the most common. It is often caused by abdominal adhesions, which increases the difficulty of diagnosis. This study aimed to explore the clinical value of dynamic plain abdominal radiography (DPAR) as a simple diagnostic method for patients with DSI due to terminal adhesion of the peritoneal shunt after VP surgery.

METHODS

A total of 30 patients with high suspicion of DSI due to abdominal adhesions after VP surgery were included. DPAR was used for prospective assessment. The interval between the first and second PAR was 4-6 h before surgery. If two plain abdominal radiography at different times indicated that the end of the shunt tube in the abdominal segment was fixed, it was diagnosed as DSI due to adhesion of the shunt tube at the abdominal end. The peritoneal end of the shunt tube was surgically repositioned. Postoperative DPAR was repeated to evaluate the distance of the shunt outlet within the abdominal segment.

RESULTS

All cases showed clinical symptoms or imaging findings of shunt insufficiency. The diagnostic accuracy of DPAR was 96.67% (29/30). The end of the shunt tube in the abdominal segment of the preoperative group was fixed with abdominal plain film twice with a mean difference of 1.74 ± 1.18 cm. The mean postoperative change in the position of the end of the shunt tube in the abdominal section was 9.36 ± 2.64 cm, showing a significant difference compared with the preoperative group (P < 0.001). The mean postoperative EVANs index (0.37 ± 0.08) was significantly lower than the preoperative (0.42 ± 0.08) (P = 0.007), Glasgow coma scale score (12.8 ± 2.69) was higher than the mean preoperative score (11.36 ± 2.43) (P = 0.013).

CONCLUSION

DPAR is a simple and effective method for the diagnosis of shunt insufficiency caused by delayed abdominal end adhesion after VP shunt.

摘要

背景

脑积水患者行脑室腹腔分流术（VP分流术）后可能出现多种并发症，其中延迟性分流功能不全（DSI）最为常见。其常由腹腔粘连引起，增加了诊断难度。本研究旨在探讨动态腹部平片（DPAR）作为一种简单的诊断方法对VP手术后因腹腔分流末端粘连导致DSI患者的临床价值。

方法

纳入30例高度怀疑因VP手术后腹腔粘连导致DSI的患者。采用DPAR进行前瞻性评估。术前第一次和第二次腹部平片间隔4 - 6小时。若不同时间的两张腹部平片显示分流管腹腔段末端固定，则诊断为因分流管腹腔端粘连导致的DSI。对分流管腹腔端进行手术重新定位。术后重复进行DPAR以评估分流出口在腹腔段内的距离。

结果

所有病例均表现出分流功能不全的临床症状或影像学表现。DPAR的诊断准确率为96.67%（29/30）。术前组分流管腹腔段末端经两次腹部平片显示固定，平均差值为1.74±1.18 cm。术后分流管腹腔段末端位置的平均变化为9.36±2.64 cm，与术前组相比差异有统计学意义（P < 0.001）。术后平均EVANs指数（0.37±0.08）显著低于术前（0.42±0.08）（P = 0.007），格拉斯哥昏迷量表评分（12.8±2.69）高于术前平均评分（11.36±2.43）（P = 0.013）。