Piatt J H, Carlson C V
Division of Neurosurgery, Oregon Health Sciences University, Portland 97201-3098.
Pediatr Neurosurg. 1993 Sep-Oct;19(5):233-41; discussion 242. doi: 10.1159/000120738.
All cerebrospinal fluid (CSF) shunt operations performed at Oregon Health Sciences University from 1976 through 1989 were reviewed retrospectively. There were 727 insertions or revisions of CSF shunts. Outcomes from these operations were studied using statistical techniques for analysis of survival data. There were 671 simple, linear shunts and 56 complex shunt systems incorporating 3-way connectors or consisting of multiple independent linear shunts. The overall estimated median survival of simple CSF shunts was 73 months, whereas the median survival of complex shunts was only 11 months (p = 0.0069). Only simple shunts were subjected to further analysis. The most important determinant of risk of obstruction was the age of the patient: children less than 2 years old were at higher risk than older patients (p < 0.00005). The risk of obstruction of a revised shunt was not different overall from the risk of failure of a new shunt, but revision of a shunt after an interval shorter than 6 months encountered a higher risk (p < 0.00005) of failure than either new shunts or shunts revised after a longer interval. The following factors had no significant influence on risk of obstruction: attending surgeon, etiology of hydrocephalus, duration of operation, time of day of operation, and whether the patient had epilepsy. Totally revised shunts lasted no longer than partially revised shunts. In children less than 2 years old, trends were observed favoring new shunts over revised shunts (p = 0.0355) and flat bottom valves over Hakim valves (p = 0.0255). The risk of shunt infection by 1 year was 8.5%.(ABSTRACT TRUNCATED AT 250 WORDS)
对1976年至1989年在俄勒冈健康科学大学进行的所有脑脊液（CSF）分流手术进行了回顾性研究。共进行了727次CSF分流管植入或修复手术。运用生存数据分析的统计技术对这些手术的结果进行了研究。其中有671个简单的线性分流管和56个复杂的分流系统，后者包含三通连接器或由多个独立的线性分流管组成。简单CSF分流管的总体估计中位生存期为73个月，而复杂分流管的中位生存期仅为11个月（p = 0.0069）。仅对简单分流管进行了进一步分析。梗阻风险的最重要决定因素是患者年龄：2岁以下儿童比年长患者面临更高风险（p < 0.00005）。修复分流管的梗阻风险总体上与新分流管失败的风险没有差异，但在间隔短于6个月后进行分流管修复比新分流管或间隔更长时间后修复的分流管面临更高的失败风险（p < 0.00005）。以下因素对梗阻风险没有显著影响：主刀医生、脑积水病因、手术时长、手术时间以及患者是否患有癫痫。完全修复的分流管持续时间不超过部分修复的分流管。在2岁以下儿童中，观察到倾向于使用新分流管而非修复分流管的趋势（p = 0.0355）以及倾向于使用平底阀而非哈金阀的趋势（p = 0.0255）。1年内分流管感染的风险为8.5%。（摘要截选至250词）
