吴黎琨　李家庆　舒凯　雷霆

华中科技大学同济医学院附属同济医院，武汉，430030

脑室腹腔分流手术失败后存在的问题及对策

吴黎琨李家庆舒凯雷霆

华中科技大学同济医学院附属同济医院，武汉，430030

摘要脑室腹腔分流手术是治疗脑积水的常用方法，其操作简便，疗效肯定，在各级医院广泛开展，但由于缺乏统一的手术操作规范，术后易出现感染、分流管堵塞等并发症，严重影响疾病转归，增加患者经济负担和心理负担。辩证看待分流手术时机，严格无菌、规范操作，积极做好心理护理及医患沟通工作是解决分流手术失败后问题的有效对策。

关键词医疗纠纷；脑室腹腔分流手术

Problems and Countermeasures after the Ventriculoperitoneal Shunt Failure

Wu Likun et al

TongjiHospital,HuazhongUniversityofScienceandTechnology,Wuhan, 430030

AbstractVentriculoperitoneal shunt is the conventional therapy for hydrocephalus with uncomplicated procedure，satisfactory outcome and wide spread in various hospitals. However, because of disparity of knowledge level and shortage of unified surgery operation，serious post-operative complications such as infection and obstruction account for worse outcome and a longer period of hospitalization, leading to increased heath care costs. Right surgery timing, standardized operation, psychological care and good doctor-patient communication are the key to solve the problems in case of shunt failure. In this paper, status quo of the hydrocephalus treatment in China was investigated and the negative influence of shunt failure on society and doctor-patient relationship was thoroughly analyzed. Useful suggestion was raised to diminish the incidence and consequence of shunt failure.

Key WordsMedical Disputes; Ventriculoperitoneal Shunt

脑脊液在蛛网膜下腔和(或)脑室系统异常积聚使其异常扩大称为脑积水。脑积水是各种原因导致的脑脊液的循环障碍，其发病率为1.0%-1.5%[1]。脑室腹腔分流术(以下简称“分流手术”)是治疗脑积水的常规手术，其操作简便，疗效肯定，但术后并发症常见，可加重病情，增加患者的经济负担和心理负担，也给医患关系带来负面影响。本文通过对脑积水脑室腹腔分流手术治疗现状进行研究，探讨手术失败后存在的问题及对策。

1 脑室腹腔分流手术治疗现状

1.1 辩证看待分流手术利弊

脑室腹腔分流术是治疗脑积水的常规手术，可显著缓解患者脑积水症状，改善患者神经功能，但是不必要的手术及术后并发症可导致一系列社会问题，因此要辩证看待分流手术。分流手术材料昂贵，且术后患者常需要终生带管，一旦出现术后并发症，会显著延长患者住院时间，增加医疗费用，并使患者及家属承受巨大的心理及生理痛苦。……