脑室-腹腔分流术的常见并发症与对策.pdf

脑室-腹腔分流术的常见并发症与对策宋明战祥新吴斌张亚卓 1 8 9 3 年，M i k u l i c z 将玻璃管插入侧脑室，另一端置于皮下，这是最早的永久性分流管，术后患者头围明显缩小 1 。到上世纪7 0 年代，脑室-腹腔分流术已成为治疗脑积水的常用手段。随着脑室-腹腔分流手术的普及，分流手术并发症逐渐增多，正确认识和处理各种术后并发症对提高患者生活质量至关重要。1 0.3 7 6 0/c m a.j.i s s n.1 0 0 1-2 3 4 6.2 0 1 1.0 4.0 3 9卫生公益性行业科研专项(2 0 0 9 0 2 0 0 4)作者单位：1 0 0 0 9 3 首都医科大学北京三博脑科医院神经外科（宋明、吴斌）；华北煤炭医学院（战祥新）；北京市神经外科研究所（张亚卓）万方数据 1 A s c h o f f A,K r e m e r P,H a s h e m i B,e t a l.T h e s c i e n t i f i c h i s t o r y o f h y d r o c e p h a l u s a n d i t s t r e a t m e n t.N e u r o s u r g R e v,1 9 9 9,2 2:6 7-9 3.2 B a r n e s N P,J o n e s S J,H a y w a r d R D,e t a l.V e n t r i c u l o p e r i t o n e a l s h u n t b l o c k:w h a t a r e t h e b e s t p r e d i c t i v e c l i n i c a l i n d i c a t o r s.?A r c h D i s C h i l d ,2 0 0 2,8 7 :1 9 8-2 0 1.3 T u l i S,D r a k e J,L a w l e s s J,e t a l.R i s k f a c t o r s f o r r e p e a t e d c e r e b r o s p i n a l s h u n t f a i l u r e s i n p e d i a t r i c p a t i e n t s w i t h h y d r o c e p h a l u s.J N e u r o s u r g,2 0 0 0,9 2 :3 1-3 8.4 B a y r a m c,N e j m i K H,S e r d a r I.V e n t r i c u l o p e r i t o n e a l s h u n t p l a c e m e n t c o m p l i c a t i o n s a n d s h u n t d i s p l a c e m e n t.T K l i n J M e d S c i,2 0 0 0,2 0 :1 1-1 3.5 P u d e n z R H,F o l t z E L。H y d r o c e p h a l u s :o v e r d r a l n a g e b y v e n t r i c u l a r s h u n t s.A r e v i e w a n d r e c o m m e n d a t i o n s.S u r g N e u r o l,1 9 9 1,3 5:2 0 0-2 1 2.6 M e i e r U,M u t z e S.C o r r e l a t i o n b e t w e e n d e c r e a s e d v e n t r i c u l a r s i z e a n d p o s i t i v e c l i n i c a l o u t c o m e f o l l o w i n g s h u n t p l a c e m e n t i n p a t i e n t s w i t h n o r m a l-p r e s s u r e h y d r o c e p h a l u s.J N e u r o s u r g,2 0 0 4,1 0 0 :1 0 3 6-1 0 4 0.7 C o l e y B D,K o s n i k E J.A b d o m i n a l c o m p l i c a t i o n s o f v e n t r i c u l o p e r i t o n e a l s h u n t s i n c h i l d r e n.S e m i n U l t r a s o u n d C T M R,2 0 0 6,2 7:1 5 2-1 6 0.8 I s a a c m a n D,P o i r i e r M,H e g e n b a r t h M,e t a l.V e n t r i c u l p e r i t o n e a l s h u n t m a n a g e m e n t.P e d i a t r i c E m e r g e n c y C a r e ,2 0 0 3,1 9 :1 1 9-1 2 5.9 M a l d o n a d o I L,V a l e r y C A,B o c h A L.S h u n t d e p e n d e n c e:m y t h s a n d f a c t s.A c t a N e u r o c h i r(W i e n),2 0 1 0,1 5 2 :1 4 4 9-1 4 5 4.1 0 K a u f m a n B,W e i s s M H,Y o u n g H F,e t a l.E f f e c t s o f p r o l o n g e d c e r e b r o s p i n a l f l u i d s h u n t i n g o n t h e s k u l l a n d b r a i n.J N e u r o s u r g,万方数据 1 9 7 3,3 8:2 8 8-2 9 7.1 1 R e k a t e H L.C l a s s i f i c a t i o n o f s l i t-v e n t r i c l e s y n d r o m e s u s i n g i n t r a c r a n i a l p r e s s u r e m o n i t o r i n g.P e d i a t r N e u r o s u r g,1 9 9 3,1 9 :1 5-2 0.1 2 B a s k i n J J,M a n w a r i n g K H,R e k a t e H L.V e n t r i c u l a r s h u n t r e m o v a l:t h e u l t i m a t e t r e a t m e n t o f t h e s l i t v e n t r i c l e s y n d r o m e.J N e u r o s u r g,1 9 9 8,8 8:4 7 8-4 8 4.1 3 W a l k e r M L,F r i e d A,P e t r o n i o J.D i a g n o s i s a n d t r e a t m e n t o f t h e s l i t v e n t r i c l e s y n d r o m e.N e u r o s u r g C l i n N A m,1 9 9 3,4:7 0 7-7 1 4.1 4 D e l B i g i o M R.N e u r o p a t h o l o g i c a l f i n d i n g s i n a c h i l d w i t h s l i t v e n t r i c l e s y n d r o m e.P e d i a t r N e u r o s u r g,2 0 0 2,3 7 :1 4 8-1 5 1.1 5 C i n a l l i G,S a i n t e-R o s e C,S i m o n I,e t a l.S y l v i a n a q u e d u c t s y n d r o m e a n d g l o b a l r o s t r a l m i d b r a i n d y s f u n c t i o n a s s o c i a t e d w i t h s h u n t m a l f u n c t i o n.J N e u r o s u r g,1 9 9 9,9 0 :2 2 7 -2 3 6.1 6 M a r o u l i s H,H a l m a g y i G M,H e a r d R,e t a l.S y l v i a n a q u e d u c t s y n d r o m e w i t h s l i t v e n t r i c l e s i n s h u n t e d h y d r o c e p h a l u s d u e t o a d u l t a q u e d u c t s t e n o s i s.J N e u r o s u r g,2 0 0 8,1 0 9:9 3 9-9 4 3.1 7 A l b r i g h t A L,T y l e r-K a b a r a E.S l i t-v e n t r i c l e s y n d r o m e s e c o n d a r y t o s h u n t-i n d u c e d s u t u r e o s s i f i c a t i o n.N e u r o s u r g e r y,2 0 0 1,4 8 :7 6 4-7 7 0.1 8 V i n c h o n M,F i c h t e n A,D e l e s t r e t I,e t a l.S h u n t r e v i s i o n f o r a s y m p t o m a t i c f a i l u r e:s u r g i c a l a n d c l i n i c a l r e s u l t s.N e u r o s u r g e r y,2 0 0 3,5 2:3 4 7-3 5 6.1 9 M c G i r t M J,B u c k I I D W,S c i u b b a D,e t a l.A d j u s t a b l e v s s e t p r e s s u r e v a l v e s d e c r e a s e t h e r i s k o f p r o x i m a l s h u n t o b s t r u c t i o n i n t h e t r e a t m e n t o f p e d i a t r i c h y d r o c e p h a l u s.C h i l d s N e r v S y s t,2 0 0 7,2 3:2 8 9-2 9 5.2 0 F a r a h m a n d D,H i l m a r s s o n H,H(o)g f e l d t M,e t a l.P e r i o p e r a t i v e r i s k f a c t o r s f o r s h o r t t e r m s h u n t r e v i s i o n s i n a d u l t h y d r o c e p h a l u s p a t i e n t s.J N e u r o l N e u r o s u r g P s y c h i a t r y ,2 0 0 9,8 0 :1 2 4 8-1 2 5 3.2 1 D i c k e r m a n R D,M c C o n a t h y W J,M o r g a n J,e t a l.F a i l u r e r a t e o f f r o n t a l v e r s u s p a r i e t a l a p p r o a c h e s f o r p r o x i m a l c a t h e t e r p l a c e m e n t i n v e n t r i c u l o p e r i t o n e a l s h u n t s:r e v i s i t e d.J C l i n N e u r o s c i,2 0 0 5,1 2:7 8 1-7 8 3.2 2 常文海，姬馨彤，张俊杰，等.脑积水分流术分流管近端位置 与疗效.中华神经外科杂志，2 0 0 4，2 0:4 8 2.2 3 M a t t h e w J,M c G i r t J C,W e l l o n s S M,e t a l.C o m p a r i s o n o f t o t a l v e r s u s p a r t i a l r e v i s i o n o f i n i t i a l v e n t r i c u l o p e r i t o n e a l s h u n t f a i l u r e s.P e d i a t r N e u r o s u r g,2 0 0 3,3 8 :3 4-4 0.2 4 S c h r e f f l e r R T,S c h r e f f l e r A J,W i t t l e r R R.T r e a t m e n t o f c e r e b r o s p i n a l f l u i d s h u n t i n f e c t i o n s :a d e c i s i o n a n a l y s i s.P e d i a t r I n f e c t D i s J,2 0 0 2,2 1:6 3 2-6 3 6.2 5 李小勇，王忠诚，李银平，等.脑积水脑室腹腔分流相关性脑 室炎治疗方案的探讨.中国危重病急救医学，2 0 0 5，1 7:5 5 8-5 6 0.2 6 蒋宇钢，张明铭.难治性脑积水分流管堵塞伴感染的神经内 镜治疗.中华神经外科杂志，2 0 0 6，2 2:5 2 2-5 2 4.2 7 T a k a h a s h i Y.W i t h d r a w a l o f t h e s h u n t s y s t e m s-c l i n i c a l u s e o f t h e p r o g r a m m a b l e s h u n t s y s t e m a n d i t s e f f c e c t s i n h y d r o c e p h a l u s i n c h i l d r e n.C h i l d s N e r v S y s t ,2 0 0 1,1 7 :4 7 2-4 7 7.2 8 张喜安，彭玉平，漆松涛，等.神经内镜控制下的分流管调整 术和拔除术8 例临床观察.南方医科大学学报，2 0 0 6，2 6：1 3 8 0-1 3 8 1.2 9 肖庆，陈国强，郑佳平，等.脑积水分流故障后的内镜治疗.中国内镜杂志，2 0 0 9，1 5:7 0 4-7 0 6.3 0 B u x t o n N,P u n t J.S u b t e m p o r a l d e c o m p r e s s i o n:t h e t r e a t m e n t o f n o n c o m p l i a n t v e n t r i c l e s y n d r o m e.N e u r o s u r g e r y,1 9 9 9,4 4 :5 1 3-5 1 9.3 1 R e k a t e H I.T h e s l i t v e n t r i c l e s y n d r o m e:a d v a n c e s b a s e d o n t e c h n o l o g y a n d u n d e r s t a n d i n g.P e d i a t r N e u r o s u r g,2 0 0 4 ,4 0 :2 5 9-2 6 3.2 0 10-1 2-0 1颈椎板切除术后颈椎稳定性的研究进展林国中王振宇马长城 S i r V i c t o r H o r s l e y 于1 8 8 7 年第一次进行颈椎椎板切除术，用于颈髓肿瘤的切除。椎板切除术包括椎板、棘突及相应的棘间韧带、棘上韧带和黄韧带等后方约束性张力带的切除。由于破坏后部结构，引起骨及韧带缺陷和神经肌肉不平衡，可能引起颈椎生物力学改变，出现弧度与活动的变化，甚至出现颈椎不稳及畸形。1 0.3 7 6 0/c m a.j.i s s n.1 0 0 1-2 3 4 6.2 0 1 1.0 4.0 4 01 0 0 1 9 1 北京大学第三医院神经外科万方数据脑室-腹腔分流术的常见并发症与对策脑室-腹腔分流术的常见并发症与对策作者：宋明，战祥新，吴斌，张亚卓作者单位：宋明,吴斌(100093,首都医科大学北京三博脑科医院神经外科)，战祥新(华北煤炭医学院)，张亚卓(北京市神经外科研究所)刊名：中华神经外科杂志英文刊名：Chinese Journal of Neurosurgery年，卷(期)：2011,27(4)被引用次数：1次 参考文献(31条)参考文献(31条)1.Aschoff A;Kremer P;Hashemi B The scientific history of hydrocephalus and its treatment 19992.Barnes NP;Jones SJ;Hayward RD Ventriculoperitoneal shunt block:what are the best predictive clinical indicators 20023.Tuli S;Drake J;Lawless J Risk factors for repeated cerebrospinal shunt failures in pediatric patients withhydrocephalus 20004.Bayramc;Nejmi KH;Serdar I Ventriculoperitoneal shunt 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重视脑积水的临床诊治与转化研究期刊论文-中华神经外科杂志2011,27(4)2.杨国科.李建民.张前进 脑室-腹腔分流术的并发症预防与治疗期刊论文-中华神经外科杂志2011,27(4)3.张广平 脑积水术后并发症的临床治疗体会期刊论文-中华神经外科杂志2011,27(4)4.梁玉敏.高国一.包映晖.丁圣豪.潘耀华.吴海波.陈磊.江基尧.LIANG Yu-min.GAO Guo-yi.BAO Ying-hui.DING Sheng-hao.PAN Yao-hua.WUHai-bo.CHEN Lei.JIANG Ji-yao 脑室-腹腔分流术中分流管腹腔端无需特殊处理期刊论文-中华神经外科杂志2011,27(4)5.张春阳.侯晓峰.孙建营.张安龙.赵立军 可调压式分流管在脑积水分流术中的应用期刊论文-中华神经外科杂志2011,27(4)6.刘吉祥.吴锋.任洪波 神经内镜下第三脑室底造瘘术治疗非交通性脑积水(附32例报告)期刊论文-中华神经外科杂志2011,27(4)7.支文勇.赵富文.褚荣涛.黄炜.程序曲.孙成法.金科.姜华.张志越.邵国平 颅脑外伤后同期行自体颅骨修补及脑室-腹腔分流术32例期刊论文-中华神经外科杂志2011,27(4)8.李智强.丁建奎.吴喜 脑出血开颅术与钻孔术治疗体会期刊论文-中华神经外科杂志2011,27(4)9.马班友.吴志峰.胡卫星.顾培元.魏栋.李立新.管蔚.苗毅.MA Ban-you.WU Zhi-feng.HU Wei-xing.GU Pei-yuan.WEI Dong.LI Li-xin.GUANWei.MIAO Yi 微创脑室-腹腔分流术的基础与临床应用期刊论文-中华神经外科杂志2011,27(4)10.肖庆.陈国强.郑佳平.武晋廷.梁晖.左焕琮.XIAO Qing.CHEN Guo-qiang.ZHENG Jia-ping.WU Jin-ting.LIANG Hui.ZUO Huan-cong 软性内镜下个性化手术治疗第四脑室流出道梗阻期刊论文-中华神经外科杂志2011,27(4)引证文献(1条)引证文献(1条)1.王海丹.张丽攀.孙滢滢 老年患者行内镜下脑脊液鼻漏修补术后并发症的护理期刊论文-中华护理杂志 2011(11)本文链接：http:/