Laproscopic Ventriculoperitoneal Shunt For Adult Idiopathic Normal Pressure Hydrocephalus

ObjectiveAlthough there are many reports about the comparative study of the two ethods of ventriculoperitoneal shunt,the literature about the effect of indwelling shunt tube in the hepatodiaphragmatic space on diaphragm under laparoscopy is rare.The clinical data of60 cases of adult hydrocephalus treated by ventriculoperitoneal shunt in our hospital were retrospectively analyzed.They were randomly divided into conventional group and laparoscopic group with 30 cases in each group.The safety and ffectiveness of ventriculoperitoneal shunt were compared between the two groups,in order to explore the clinical value of laparoscopic assisted ventriculoperitoneal shunt in the treatment of adult hydrocephalus.MethodsFrom September 2017 to September 2020,60 adult patients with hydrocephalus underwent ventriculoperitoneal shunt in our hospital.They were randomly divided into conventional group and laparoscopic group,30 cases in each group.In the conventional group,the distal end of the shunt tube was bluntly inserted into the corresponding part of the abdominal cavity with open technique.In the laparoscopic group,the distal end of the shunt tube was sent to the right diaphragmatic surface of the liver under the guidance of laparoscopy,and the tail end of the shunt tube was accurately fixed to the ligament teres hepatis.The exhaust time,average hospital stay,i NPH score,corpus callosum angle and Evans index were compared between the two groups.Six months after operation,the clinical efficacy was evaluated by salmon standard.The total effective rate and significant therapeutic efficiency of the two groups were compared between the two groups.The postoperative complications such as gastrointestinal symptoms,catheter migration,abdominal organ injury,shunt blockage and postoperative infection were observed,and the total incidence of postoperative complications was compared between the two groups.ResultThe postoperative exhaust time and average hospital stay and i NPH score in the laparoscopic group were significantly lower than those in the conventional group（P <0.05）,but there was no significant difference in the improvement of corpus callosum angle and Evans index between the two groups after 6 months of follow-up（P >0.05）.The total effective rate in the laparoscopic group（86.7%）was significantly higher than that in the conventional group（66.7%）,and the significant effective rate in the laparoscopic group（86.7%）was also significantly higher than that in the conventional group（66.7%）,the difference between the two groups was statistically significant（P <0.05）.The total incidence of postoperative complications in the laparoscopic group（30.0%）was significantly lower than that in the conventional group（76.7%）,and the difference between the two groups was statistically significant（P < 0.05）.Although the number of patients with gastrointestinal symptoms in laparoscopic group is less than that in conventional group,it is not enough for statistical analysis.Conclusion1.Laparoscopy assisted VPS is a safe and effective method for the treatment of adult i NPH hydrocephalus.2.Laparoscopy assisted VPS can improve the clinical cure rate of adult i NPH hydrocephalus and the incidence of complications is low.