当前位置: X-MOL 学术Childs Nerv. Syst. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Ventriculoatrial and ventriculopleural shunts as second-line surgical treatment have equivalent revision, infection, and survival rates in paediatric hydrocephalus.
Child's Nervous System ( IF 1.4 ) Pub Date : 2020-09-28 , DOI: 10.1007/s00381-020-04887-x
Dalila Forte 1 , Simone Peraio 1 , Terhi J Huttunen 1 , Greg James 1 , Dominic Thompson 1 , Kristian Aquilina 1
Affiliation  

Purpose

Ventriculoatrial (VA) and ventriculopleural (VPL) shunts are used as alternatives when CSF diversion to the peritoneal compartment with a ventriculoperitoneal (VP) shunt is not possible. The objective of this study is to compare directly the shunt survival and complications for both procedures in this setting in children.

Methods

A retrospective analysis of 54 consecutive patients who underwent VA (36) or VPL (18) shunt insertion between January 2002 and December 2017 was conducted.

Results

The overall mean follow-up was 4.1 (SD 4.3) years, 2.8 (SD 4.1) for VPL and 4.7 (SD 4.4) for VA shunts, respectively (p = 0.11). Twenty-four (66.7%) patients in the VA group and 9 (50.0%) in the VPL group underwent shunt revision (p = 0.236); mean number of revisions was 2.2 (SD 3.0) and 0.94 (SD 1.4) in the VA and VPL groups (p = 0.079). Median time to failure was 8.5 (IQr 78, range 0–176) months for VA and 5.50 (IQr 36, range 0–60) for VPL shunts (log rank (Mantel-Cox) 0.832). Shunt survival at 3, 6, 12 and 30 months was 60.6, 51.5, 36.4 and 27.3%, respectively, for VA and 56.3, 43.8, 37.5 and 37.5% for VPL shunts (log rank (Mantel-Cox) test value 0.727). The infection rate was 13.8% for VA and 5.6% for VPL shunts (p = 0.358). Four patients with VPL shunts (22.2%) developed pleural effusions. Fourteen deaths (25.9%) were recorded during follow-up, 8 (22.2%) in the VA and 6 (33.3%) in the VPL group (p = 0.380); two of the deaths in the VA group were shunt-related.

Conclusion

This study demonstrates that the outcomes of VA and VPL shunts, when used as second-line surgical treatment in paediatric hydrocephalus, were similar, as were the revision, infection and survival rates. The shorter longevity of these shunts compared with the general shunted population may reflect the complex nature of these children.



中文翻译:

脑室心房和脑室胸膜分流术作为二线手术治疗对小儿脑积水的翻修率、感染率和生存率相当。

目的

当脑室腹腔 (VP) 分流无法将脑脊液转移至腹膜腔室时,可使用心室心房 (VA) 和脑室胸膜 (VPL) 分流器作为替代方案。本研究的目的是直接比较这两种手术在儿童中的分流存活率和并发症。

方法

对 2002 年 1 月至 2017 年 12 月期间接受 VA (36) 或 VPL (18) 分流插入的 54 名连续患者进行了回顾性分析。

结果

总体平均随访时间分别为 4.1 (SD 4.3) 年,VPL 为 2.8 (SD 4.1),VA 分流术为 4.7 (SD 4.4) ( p  = 0.11)。VA 组 24 名(66.7%)患者和 VPL 组 9 名(50.0%)患者接受了分流修复(p  = 0.236);VA 和 VPL 组的平均修订次数为 2.2 (SD 3.0) 和 0.94 (SD 1.4) ( p  = 0.079)。VA 的中位失效时间为 8.5(IQr 78,范围 0-176)个月,VPL 分流器的中位失效时间为 5.50(IQr 36,范围 0-60)(对数秩 (Mantel-Cox) 0.832)。3、6、12 和 30 个月的分流存活率分别为 60.6、51.5、36.4 和 27.3%,VA 和 VPL 分流的 56.3、43.8、37.5 和 37.5%(对数秩 (Mantel-Cox) 检验值 0.727)。VA 的感染率为 13.8%,VPL 分流的感染率为 5.6%(p = 0.358)。4 名 VPL 分流患者 (22.2%) 出现胸腔积液。随访期间记录了 14 例死亡(25.9%),VA 组 8 例(22.2%)和 VPL 组 6 例(33.3%)(p  = 0.380);VA 组中有两例死亡与分流有关。

结论

本研究表明,VA 和 VPL 分流器在用作小儿脑积水的二线手术治疗时的结果相似,翻修率、感染率和生存率也相似。与一般分流人群相比,这些分流者的寿命较短可能反映了这些儿童的复杂性。

更新日期:2020-09-28
down
wechat
bug