背景:脑室腹膜(VP)分流术是一种分流脑脊液(CSF)以治疗脑积水的方法。修订率,操作时间,和腹腔镜插入远端导管后的住院时间(LOS)已混合。关于VP分流插入过程中粘连松解作用的数据有限。瓣膜特性也已显示影响患者结果。关于这些变量对分流结果的影响的澳大利亚数据报告很少。我们的目的是研究患者的人口统计学,适应症,以及澳大利亚背景下的手术和器械变量。
方法:我们进行了回顾性研究,多外科医生,通过开放或腹腔镜技术插入成人VP分流器的单中心分析。从医院医疗记录和澳大利亚分流登记处收集了有关患者人口统计学和手术特征的数据。主要结果是分流翻修率,次要结果是术后并发症,操作时间和LOS,和分流生存能力。
结果:56名参与者符合分析条件。整体修订率为14.3%,低于全国平均水平。远端导管翻修率为0%。腹腔镜下插入远端导管可显著缩短手术时间(开腹组70.4min,腹腔镜组50.7min,p<0.001)。这在不同的病因上得到了证明,当控制年龄和瓣膜类型时(p<0.05)。非可编程阀的修订率高于可编程阀(42.9%对2.9%,分别)。以前的腹部手术没有区别,LOS,并发症,或开放和腹腔镜插入之间的翻修率。腹腔镜组的VP分流存活率更高(腹腔镜组和开腹组的90天分流存活率分别为96.7%和92%,分别为;p>0.05)。我们没有发现手术时间或住院时间的年龄有任何显著差异,性别,或者以前的腹部手术,即使考虑到手术技术。不同年龄段的适应症和分流生存能力差异很大。腹腔镜插入的使用随着时间的推移而增加,尽管外科医生没有交叉技术。
结论:VP分流的整体远端翻修率较低。腹腔镜下插入远端导管可减少手术时间,并可提高分流器的生存能力。需要更大规模的研究来确认开放与腹腔镜远端导管插入的分流存活性差异,年龄组之间,临床适应症,和瓣膜类型对患者预后的影响。
BACKGROUND: Ventriculoperitoneal (VP) shunt insertion is a means of diverting cerebrospinal fluid (CSF) for management of hydrocephalus. Revision rates, operating time, and length of stay (LOS) following laparoscopic insertion of the distal catheter have been mixed. There are limited data on the role of adhesiolysis during VP shunt insertion. Valve characteristics have also been shown to influence patient outcomes. There is a paucity of Australian data reporting on the effect of these variables on shunt outcomes. We aimed to study patient demographics, indications, and surgical and instrument variables in the Australian context.
METHODS: We performed a retrospective, multi-surgeon, single-centre analysis of VP shunts inserted in adults via an open or laparoscopic technique. Data on patient demographics and surgery characteristics were collected from the hospital medical records and the Australasian Shunt Registry. The primary outcome was shunt revision rate and secondary outcomes were postoperative complications, operating time and LOS, and shunt survivability.
RESULTS: Fifty-six participants were eligible for analysis. The overall revision rate was 14.3 %, which was lower than the national average. The distal catheter revision rate was 0 %. Laparoscopic insertion of the distal catheter was shown to significantly reduce operating time (70.4 min in the open group and 50.7 min in the laparoscopic group, p < 0.001). This was demonstrated across different aetiologies, and when controlling for age and valve-type (p < 0.05). The revision rate of non-programmable was higher than programmable valves (42.9 % versus 2.9 %, respectively). There were no differences between previous abdominal surgery, LOS, complication, or revision rate between open and laparoscopic insertion. VP shunt survivability was greater in the laparoscopic group (90-day shunt survival of 96.7 % and 92 % in the laparoscopy and open groups, respectively; p > 0.05). We did not find any significant difference in operating time or length of stay for age, sex, or previous abdominal surgery, even when accounting for surgical technique. Indication and shunt survivability varied widely between age groups. The use of laparoscopic insertion increased over time, though surgeons did not crossover techniques.
CONCLUSIONS: The overall distal revision rate of VP shunts is low. Laparoscopic insertion of the distal catheter reduces operating time and may improve shunt survivability. Larger studies are needed to confirm differences in shunt survivability in open versus laparoscopic distal catheter insertion, between age groups, clinical indications, and valve type on patient outcomes.