新型腹腔穿刺針與單孔腹腔鏡聯(lián)合在腦室腹腔分流術(shù)治療腦積水中的應(yīng)用
發(fā)布時(shí)間：2018-11-18 16:47
【摘要】：腦積水是腦脊液產(chǎn)生或（和）循環(huán)吸收過程發(fā)生障礙而致顱內(nèi)腦脊液量蓄積，顱內(nèi)壓力增高，使正常的腦脊液循環(huán)系統(tǒng)擴(kuò)大，產(chǎn)生一系列相應(yīng)的顱內(nèi)壓增高及神經(jīng)系統(tǒng)損傷的疾病的總稱。腦積水是一種病理生理結(jié)果，根據(jù)病因分為原發(fā)性和繼發(fā)性兩種，發(fā)病率2% 2.5%，多表現(xiàn)為步態(tài)不穩(wěn)、尿失禁及認(rèn)知功能下降，為家庭及社會(huì)帶來了沉重的經(jīng)濟(jì)及精神負(fù)擔(dān)，是神經(jīng)外科急于解決的疾病之一。 目前治療腦積水的方法有很多，包括腦室腹腔分流術(shù)、腦室心房分流術(shù)、腰大池腹腔分流術(shù)、神經(jīng)內(nèi)鏡下第三腦室底造漏術(shù)等。其中腦室腹腔分流術(shù)（ventriculo peritonealshunt, VPS）是目前神經(jīng)外科醫(yī)生最常用、也是最安全有效的方法，但是該手術(shù)極易出現(xiàn)并發(fā)癥，如感染、分流管遠(yuǎn)端堵塞等，而且這些并發(fā)癥多發(fā)生在腦室腹腔分流管的腹腔端。有文獻(xiàn)報(bào)道，VPS后的感染多發(fā)生在2個(gè)月內(nèi)，這就說明感染發(fā)生的原因產(chǎn)生于腦室腹腔分流管的置入過程中。目前腦室腹腔分流術(shù)腹腔端的置入方法主要有三大類：開腹置入分流管腹腔端、穿刺針類的置入分流管腹腔端及腹腔鏡下置入分流管腹腔端，但這些方法并沒有完全解決手術(shù)操作創(chuàng)傷大、術(shù)中分流管堵塞及大網(wǎng)膜包裹、感染等并發(fā)癥的產(chǎn)生。 我們回顧性分析48例采用新型腹腔穿刺針經(jīng)臍單孔腹腔鏡行腦室腹腔分流術(shù)治療腦積水患者的臨床資料。發(fā)現(xiàn)新型腹穿針組手術(shù)時(shí)間及腹部切口長度明顯低于傳統(tǒng)手術(shù)組，而傳統(tǒng)手術(shù)組的感染及分流管堵塞的并發(fā)癥遠(yuǎn)遠(yuǎn)高于新型腹穿針組。證實(shí)我們應(yīng)用新型腹腔穿刺針聯(lián)合腹腔鏡進(jìn)行VPS腹腔端置入，具有較多優(yōu)勢(shì)，，如創(chuàng)傷小、手術(shù)視野開闊、減少并發(fā)癥的發(fā)生等，特別是在肥胖、既往腹部手術(shù)史或分流管腹腔端調(diào)整術(shù)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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1
本文編號(hào)：2340575
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 陳國明,蔡濤;腦室-腹腔分流術(shù)后并發(fā)癥分析[J];第一軍醫(yī)大學(xué)學(xué)報(bào);2004年09期
2 陳祖鵬;沈宏;;特發(fā)性正常顱壓腦積水的診斷與治療進(jìn)展[J];國際神經(jīng)病學(xué)神經(jīng)外科學(xué)雜志;2006年02期
本文編號(hào)：2340575
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