新型腹腔穿刺针与单孔腹腔镜联合在脑室腹腔分流术治疗脑积水中的应用

发布时间：2018-11-18 16:47

【摘要】：脑积水是脑脊液产生或（和）循环吸收过程发生障碍而致颅内脑脊液量蓄积，颅内压力增高，使正常的脑脊液循环系统扩大，产生一系列相应的颅内压增高及神经系统损伤的疾病的总称。脑积水是一种病理生理结果，根据病因分为原发性和继发性两种，发病率2% 2.5%，多表现为步态不稳、尿失禁及认知功能下降，为家庭及社会带来了沉重的经济及精神负担，是神经外科急于解决的疾病之一。目前治疗脑积水的方法有很多，包括脑室腹腔分流术、脑室心房分流术、腰大池腹腔分流术、神经内镜下第三脑室底造漏术等。其中脑室腹腔分流术（ventriculo peritonealshunt, VPS）是目前神经外科医生最常用、也是最安全有效的方法，但是该手术极易出现并发症，如感染、分流管远端堵塞等，而且这些并发症多发生在脑室腹腔分流管的腹腔端。有文献报道，VPS后的感染多发生在2个月内，这就说明感染发生的原因产生于脑室腹腔分流管的置入过程中。目前脑室腹腔分流术腹腔端的置入方法主要有三大类：开腹置入分流管腹腔端、穿刺针类的置入分流管腹腔端及腹腔镜下置入分流管腹腔端，但这些方法并没有完全解决手术操作创伤大、术中分流管堵塞及大网膜包裹、感染等并发症的产生。我们回顾性分析48例采用新型腹腔穿刺针经脐单孔腹腔镜行脑室腹腔分流术治疗脑积水患者的临床资料。发现新型腹穿针组手术时间及腹部切口长度明显低于传统手术组，而传统手术组的感染及分流管堵塞的并发症远远高于新型腹穿针组。证实我们应用新型腹腔穿刺针联合腹腔镜进行VPS腹腔端置入，具有较多优势，，如创伤小、手术视野开阔、减少并发症的发生等，特别是在肥胖、既往腹部手术史或分流管腹腔端调整术的患者。
[Abstract]:Hydrocephalus is the accumulation of cerebrospinal fluid (CSF) in the cerebrospinal fluid (CSF) due to the disturbance of cerebrospinal fluid (CSF) production or / or circulatory absorption, resulting in the increase of intracranial pressure and the expansion of the normal cerebrospinal fluid circulatory system. A group of diseases that result in a corresponding increase in intracranial pressure and nervous system damage. Hydrocephalus is a pathophysiological result. According to the etiology, hydrocephalus is divided into primary and secondary. The incidence of hydrocephalus is 2. 5% or 2. 5%, most of which are gait instability, urinary incontinence and decreased cognitive function. It brings a heavy economic and mental burden to the family and society, and is one of the diseases that neurosurgery is eager to solve. At present, there are many methods to treat hydrocephalus, including ventriculoperitoneal shunt, ventricular atrial shunt, lumbar cistern celiac shunt, endoscope third ventricle fundus leakage and so on. Among them, (ventriculo peritonealshunt, VPS) is the most commonly used and safe and effective method for neurosurgeons at present. However, the operation is prone to complications, such as infection, blockage of distal shunt tube, etc. These complications often occur at the abdominal end of the ventriculoperitoneal shunt. It has been reported that the infection after VPS occurs within 2 months, which indicates that the cause of infection is caused by the placement of the ventriculoperitoneal shunt. At present, there are three main methods for the placement of ventriculoperitoneal shunt: open placement of shunt tube celiac end, puncture needle placement of shunt tube celiac end and laparoscopic placement of shunt tube celiac end. However, these methods have not completely solved the complications such as trauma in operation, blockage of shunt tube, greater omentum encapsulation, infection and so on. We retrospectively analyzed the clinical data of 48 patients with hydrocephalus treated by new type intraperitoneal puncture needle transumbilical laparoscopic ventriculoceliac shunt. It was found that the operative time and the length of abdominal incision in the new type abdominal puncture group were significantly lower than those in the traditional operation group, while the infection and the complications of shunt tube blockage in the traditional operation group were much higher than those in the new type abdominal puncture group. It is proved that we use the new type of intraperitoneal puncture needle combined with laparoscopy to put VPS into the abdominal cavity, which has many advantages, such as less trauma, wider operation field, less complications and so on, especially in obesity. Patients with previous abdominal surgery or shunt tube celiac end-adjustment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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