Hoy Tom, Harbison Annabelle M, Campbell Robert A J, Coulthard Liam G, Colbran Rachel E, Stuart Michael J
Department of Neurosurgery, Townsville University Hospital, Townsville, QLD, 4814, Australia.
Department of Neurosurgery, Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia.
Childs Nerv Syst. 2025 Sep 25;41(1):290. doi: 10.1007/s00381-025-06963-6.
There is currently little evidence to guide the management of ventricular-peritoneal shunts during subsequent intraperitoneal procedures, and the influence of these procedures on the risk of shunt malfunction is poorly understood.
A ten-year single institution retrospective analysis was undertaken to identify all paediatric patients with ventriculoperitoneal shunts. Statewide electronic medical records were reviewed to determine whether the patient had undergone any subsequent intraperitoneal procedures, and if so, how the shunt was managed during the procedure. Intraperitoneal procedures were divided into elective and emergency categories. Shunt survival was compared with patients not undergoing subsequent intraperitoneal procedures in time-dependent univariate and multivariate Cox proportional hazard models.
A total of 1084 shunt-related procedures were performed in 472 patients, of which 45 patients underwent elective and 15 patients underwent emergency intraperitoneal procedures during a mean follow-up of 4.85 years. The most common elective procedures were considered 'clean' procedures-gastrostomies 17 (38%) and hernia repairs 13 (29%), in addition to 8 (18%) 'clean-contaminated' colostomy or colectomy procedures. No significant association of elective intraperitoneal procedures with earlier shunt failure was found on univariate or multivariate analysis (HR 1.18, 95% CI 0.57-2.44, p = 0.66). Of patients presenting with an acute abdomen requiring surgical intervention, 4/15 (27%) were secondary to shunt infection, which increases to 4/6 (66%) in those without a clear preoperative alternative diagnosis.
The performance of an elective intra-peritoneal procedure on a patient with a ventriculoperitoneal shunt in situ does not appear to increase the risk of subsequent shunt malfunction.
目前几乎没有证据可指导在后续腹腔内手术期间对脑室 - 腹腔分流术的管理，并且这些手术对分流器故障风险的影响了解甚少。
进行了一项为期十年的单机构回顾性分析，以确定所有患有脑室 - 腹腔分流术的儿科患者。审查全州范围内的电子病历，以确定患者是否接受了任何后续腹腔内手术，如果是，在手术期间分流器是如何管理的。腹腔内手术分为择期和急诊两类。在时间依赖性单变量和多变量Cox比例风险模型中，将分流器存活情况与未接受后续腹腔内手术的患者进行比较。
在472例患者中总共进行了1084例与分流器相关的手术，其中45例患者在平均4.85年的随访期间接受了择期腹腔内手术，15例患者接受了急诊腹腔内手术。最常见的择期手术被认为是“清洁”手术——胃造口术17例（38%）和疝气修补术13例（29%），此外还有8例（18%）“清洁 - 污染”的结肠造口术或结肠切除术。在单变量或多变量分析中，未发现择期腹腔内手术与早期分流器故障有显著关联（风险比1.18，95%置信区间0.57 - 2.44，p = 0.66）。在需要手术干预的急腹症患者中，4/15（27%）继发于分流器感染，在没有明确术前替代诊断的患者中这一比例增加到4/6（66%）。
对原位脑室 - 腹腔分流术患者进行择期腹腔内手术似乎不会增加后续分流器故障的风险。
