【摘要】 目的 探讨用血管导管鞘引导脑室腹腔分流管进入腹腔治疗脑积水的效果。方法 选择符合有脑室腹腔分流术适应证的脑积水病人10例，利用8F以上血管导管鞘，以Seldinger技术将脑室腹腔分流管导入腹腔，导管鞘退出或剪劈分开取出，分流管通过头颈胸皮下金属捅管道，与分流阀相接。结果 10例病人均成功顺利放置分流管，手术时间短;术后未见腹部并发症。结论 导管鞘引导腹腔分流管进入腹腔，是脑积水脑室腹腔分流手术腹部创伤最小和最简单的方法。
【关键词】 导管鞘;导管插入术;脑室腹膜分流术
PLACEMENT OF VENTRICULOPERITONEAL SHUNT CATHETER GUIDED BY CATHETER SHEATH FOR THE THERAPY OF HYDROCEPHALUS
QI WEIGUO, LI HUANTING, CHEN XIAODONG
Department of Neurosurgery, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266003, China);
[ABSTRACT] Objective To observe the therapeutic effect of ventriculoperitoneal shunt guided by vessel catheter sheath to treat the patients with hydrocephalus. Methods Ten patients with hydrocephalus were included in this study. An 8F vessel catheter sheath was inserted into abdominal cavity with Seldinger technique. The ventriculoperitoneal shunt pipe was guided into the abdominal cavity through the sheath. The sheath was withdrawn or removed splitly. Results All the pipes were placed smoothly. Operative time was short. No postoperative abdominal complications were observed. Conclusion A catheter inserted into abdominal cavity guided by catheter sheath is the least wound of abdomen and the simplest method of ventriculoperitoneal shunt in the treatment of hydrocephalus.
[KEY WORDS] catheter sheath; catheterization; ventriculoperitoneal shunt
脑积水手术治疗最常用的方法是脑室腹腔分流术。脑室腹腔分流管送入腹腔的方法有腹壁切开、腹腔镜Trocar针、腹穿套管针等[13]。作者应用血管导管鞘引导腹腔分流管入腹腔的方法治疗脑积水，简单省时, 微创安全。现报告如下。
1 资料和方法
1.1 一般资料
2005年7月—2009年6月，选择诊断明确的脑积水病人10例，男6例，女4例;年龄20～70岁。病因为外伤、蛛网膜下隙出血、烟雾病。具备常规脑室腹腔分流手术的适应证，无禁忌证。
1.2 置管方法
术前准备和分流管种类选择以及脑室端放置，与常规分流术相同。分流管的生产公司不同，腹腔端与压力阀的结构不同，手术放置腹部分流管的先后顺序不同。本组采用腹端分流管先导入腹腔法9例，采用腹端分流管后导入腹腔法1例。
1.2.1 腹端分流管先导入腹腔法
适应于PHOENIX分流管和MEDTRONIC分流管，该类分流管能够通过皮下捅管。选择8F导管鞘(Terumo公司或Cordis公司生产)。穿刺位置在右下腹或右上腹，与常规腹腔穿刺点一样;腹壁切一约5 mm小口至皮下,以便皮下捅管引出。巾钳提起腹部皮肤，用Seldinger技术插
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