脑室-腹腔分流术治疗小儿脑积水的并发症分析

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[摘要] 目的 分析脑室-腹腔分流术（VPS）治疗小儿脑积水的并发症。 方法 脑积水患儿185例，所有患儿均行VPS治疗。术后通过门诊和电话定期对患儿进行随访，记录并分析患儿并发症诊治情况和原因，统计并发症的发生率。 结果 157例患儿术后无并发症发生，28例患儿术后出现并发症，发生率为15.14%。主要并发症为分流管阻塞（4.9%）和感染（4.3%），主要阻塞原因为脑室粘连、纤维组织阻塞、管口滑落脑室腔外、管口囊肿包裹和大网膜包裹，主要感染因素为迁延性脑膜炎、皮下积液、皮肤破溃和肠道逆行感染。 结论 VPS治疗小儿脑积水术后并发症以分流管阻塞和感染多见，有效预防和治疗并发症可提高VPS术后疗效。

[关键词] 脑室-腹腔分流术；脑积水；儿童；并发症

[中图分类号] R726.1 [文献标识码] A [文章编号] 1674-4721（2012）07（b）-0057-02

Analysis of complications of ventriculo-peritoneal shunt in the treatment of pediatric hydrocephalus

FENG Shubin LU Shan QI Lin

Department of Neurosurgery, Children's Hospital of Zhengzhou City in He'nan Province, Zhengzhou 450053, China

[Abstract] Objective To analyze the complications of ventriculo-peritoneal shunt in the treatment of pediatric hydrocephalus. Methods One hundred and eighty-five cases of hydrocephalus children were treated with ventriculo-peritoneal shunt (VPS). All children were followed up after operation by means of outpatient service and telephone, the diagnosis and treatment situation of complications of children was recorded and the reasons were analyzed, the incidence of complications was done statistics. Results One hundred and fifty-seven cases of children had no incidence of complications, and 28 cases suffered with complications after operation, the incidence rate was 15.14%. Shunt tube obstruction (4.9%) and infection (4.3%) were the main complications. Ventricle adhesion, fibre obstruction, shunt tube sliding out of ventricular cavity, tube mouth cyst and tube parcel were the main reasons of obstruction. Chronic meningitis, subcutaneous effusion, skin ulceration and intestinal retrograde infection were the main reasons of infection. Conclusion Shunt tube obstruction and infection are the main postoperative complications of VPS in the treatment of pediatric hydrocephalus. Effective prevention and treatment of complications can enhance the postoperative effect of VPS.

[Key words] Ventriculo-peritoneal shunt; Hydrocephalus; Children; Complications

脑积水是小儿神经外科常见疾病之一。由于脑脊液循环通路阻塞使脑脊液在颅内大量积聚，而导致脑室进行性扩大，脑室周围组织缺血缺氧、水肿变性，引起大脑发育不良和各种神经功能障碍，影响患儿生长发育和身心健康，如何有效治疗脑积水是儿科临床医生十分关注的问题[1]。目前，手术是治疗小儿脑积水最有效的方法，特别是脑室-腹腔分流术（ventriculoperitoneal shunting，VPS）创伤小、操作简单，可以解除脑脊液循环障碍，使脑脊液的分泌与吸收得到平衡，降低颅内高压，达到治疗脑积水的目的，但术后并发症发生率较高[2]，降低VPS术后并发症的发生率是提高手术疗效的关键。近年来，已有少数文献对VPS治疗小儿脑积水的并发症进行报道，但仍有争议。本研究对VPS治疗185例脑积水患儿并发症的情况进行分析，来探讨其预防和治疗方法。

1 资料与方法

1.1 一般资料

选取2005年1月～2010年12月本院神经外科诊治的脑积水患儿185例。其中，男107例，女78例；年龄1个月～8岁，平均（3.3±1.9）岁。先天性脑积水87例、脑积水合并脑肿瘤32例、外伤及出血后脑积水23例、结核性脑膜炎性脑积水12例、细菌性脑膜炎性脑积水18例、脑积水并颅窝囊肿8例、脑积水并脊髓脊膜膨出5例。主要临床表现：头围增大、前囟饱满、颅压增加（头痛、恶心、呕吐、意识障碍）、癫痫发作等。所有患者经头部CT和（或）MRI检查确诊为脑积水，脑室系统呈对称性扩大，并以侧脑室扩大为主；采用Vassilouthis法，根据患者头颅CT和（或）MRI片子进行脑室-颅比测定，判断脑积水程度，所有患者术前脑室增大程度达到Vassilouthis所描述的2级以上。