A SEARCH FOR DETERMINANTS OF CEREBROSPINAL-FLUID SHUNT SURVIVAL - RETROSPECTIVE ANALYSIS OF A 14-YEAR INSTITUTIONAL EXPERIENCE
A SEARCH FOR DETERMINANTS OF CEREBROSPINAL-FLUID SHUNT SURVIVAL - RETROSPECTIVE ANALYSIS OF A 14-YEAR INSTITUTIONAL EXPERIENCE
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DOI：
10.1159/000120738
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发表时间：
1993-09-01
影响因子：
0.7
通讯作者：
CARLSON, CV
中科院分区：
文献类型：
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作者：
PIATT, JH;CARLSON, CV
回顾性分析了1976年至1989年在俄勒冈州健康科学大学进行的所有脑脊液（CSF）分流手术。有727例CSF分流管插入或翻修。使用统计技术分析生存数据，研究这些手术的结果。有671个简单的线性分流和56个复杂的分流系统，包括3路连接器或由多个独立的线性分流组成。简单CSF分流术的总体估计中位生存期为73个月，而复杂分流术的中位生存期仅为11个月（p = 0.0069）。仅对简单分流进行进一步分析。梗阻风险最重要的决定因素是患者的年龄：小于2岁的儿童比年龄较大的患者风险更高（p < 0.00005）。翻修分流管的阻塞风险与新分流管的失败风险总体上没有差异，但间隔时间短于6个月后翻修分流管的失败风险高于新分流管或间隔时间较长后翻修分流管（p < 0.00005）。以下因素对梗阻风险无显著影响：主治医生、脑积水病因、手术持续时间、手术时间和患者是否患有癫痫。完全翻修分流术的持续时间不长于部分翻修分流术。在2岁以下儿童中，观察到新分流管优于翻修分流管（p = 0.0355）和平底阀优于Hakim阀（p = 0.0255）的趋势。1年时分流道感染的风险为8.5%。年龄小于6个月的患者的分流术比年龄较大的患者的分流术遇到更高的感染风险（p = 0.0452）。以下因素对感染风险无显著影响：主治医生、脑积水病因、手术持续时间、手术时间以及分流管是新的还是翻修的。脑室系统分隔的患者可能受益于间室开窗术，以允许通过简单的分流系统进行CSF引流。否则，外科医生控制下的因素对分流存活率的影响程度似乎低于患者自身因素。手术技术和分流设计的前瞻性研究必须纳入患者年龄分层。
All cerebrospinal fluid (CSF) shunt operations performed at Oregon Health Sciences University from 1976 through 1989 were reviewed retrospectively. There were 727 insertions or revisions of CSF shunts. Outcomes from these operations were studied using statistical techniques for analysis of survival data. There were 671 simple, linear shunts and 56 complex shunt systems incorporating 3-way connectors or consisting of multiple independent linear shunts. The overall estimated median survival of simple CSF shunts was 73 months, whereas the median survival of complex shunts was only 11 months (p = 0.0069). Only simple shunts were subjected to further analysis. The most important determinant of risk of obstruction was the age of the patient: children less than 2 years old were at higher risk than older patients (p < 0.00005). The risk of obstruction of a revised shunt was not different overall from the risk of failure of a new shunt, but revision of a shunt after an interval shorter than 6 months encountered a higher risk (p < 0.00005) of failure than either new shunts or shunts revised after a longer interval. The following factors had no significant influence on risk of obstruction: attending surgeon, etiology of hydrocephalus, duration of operation, time of day of operation, and whether the patient had epilepsy. Totally revised shunts lasted no longer than partially revised shunts. In children less than 2 years old, trends were observed favoring new shunts over revised shunts (p = 0.0355) and flat bottom valves over Hakim valves (p = 0.0255). The risk of shunt infection by 1 year was 8.5%. Shunts in patients less than 6 months of age encountered a higher risk of infection than shunts in older patients (p = 0.0452). The following factors had no significant influence on the risk of infection: attending surgeon, etiology of hydrocephalus, duration of operation, time of day of operation, and whether the shunt was new or revised. Patients with compartmentalized ventricular systems may benefit from fenestration of compartments to permit CSF drainage through a simple shunt system. Otherwise, factors under the control of the surgeon seem to influence shunt survival to a lesser degree than factors intrinsic to the patient. Prospective studies of surgical technique and shunt design must incorporate stratification of patients by age.