摘要
目的总结微型腹腔镜下脑室腹腔分流术(ventriculo-peritoneal shunt,V-P分流术)治疗脑积水的经验. 方法 2000年11月～2004年5月,我院对28例脑积水行微型腹腔镜下V-P分流术,在脐下做5 mm皮肤切口入镜,剑突偏右穿刺0.3 cm套管针在肝圆韧带右侧进入腹腔,右腋前线肝膈面体表投影处1.5 mm深达皮下的戳孔,先后穿入带4号不吸收真丝缝线的缝针,抓钳从剑突下套管针中进入腹腔将2条缝线端从腹腔带出,将其缝合分引流管固定,从戳孔外两线端收紧结扎,引流管即从剑突下套管针中进入腹腔固定在肝膈间隙,经皮下隧道将分引流管送至头部. 结果手术均获成功,腹腔内置管手术时间5～10 min.术后颅高压症消失,未发生与腹腔镜手术相关的并发症.25例随访6～36个月,平均12个月,无引流管堵塞. 结论微型腹腔镜下V-P分流术具有创伤小、显露定位好及患者恢复快的优点.
Objective To summarize the experience of ventriculo-peritoneal (V-P) shunt under micro-laparoscope for the treatment of hydrocephalus. Methods Twenty-eight patients with hydrocephalus were treated by V-P shunt under micro-laparoscope from November 2000 to May 2004. An infraumbilical trocar was placed through a 5 mm incision to introduce the operating laparoscope. Under laparoscopic visualization, a 3 mm trocar was introduced into the abdominal cavity along the right side of the ligamentum teres hepatis through an incision just to the right of the xiphoid process. A 1.5 mm subcutaneous incision at the corresponding site of the diaphragmatic surface of the liver on the right anterior axillary line was made and through it a sewing needle with 4-gauge unabsorbable silk suture was delivered into. A grasping forceps was inserted through the xiphoid port into the abdominal cavity to carry the two sides of the suture out. The V-P tubing was fixed in the interspace between the liver and the diaphragm by the ligation from the outside, and then was tunneled to the head. Results All the operations were successfully accomplished. The operation time for iutraabdominal tube placement was 5~10 min.All the patients experienced complete alleviation of symptoms of intracranial hypertension postoperatively. No surgical complications occurred.Follow-up check-ups for 6~36 months(mean,12 months) in 25 patients found no tube obstruction. Conclusions Ventriculo-peritoneal shunt under micro-laparoscope has the advantages of minimal invasion, precise positioning, excellent visualization and rapid recovery, being a safe and feasible method which is worthy of recommendation.
出处
《中国微创外科杂志》
CSCD
2005年第2期146-147,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
微型腹腔镜
脑室腹腔分流术
脑积水
Micro-laparoscope
Ventriculo-peritoneal shunt
Hydrocephalus
