一個罕見的腦室腹腔引流手術自腹腔穿出皮膚的併發症以及其治療

A Rare Case of Peritoneal Catheter Spontaneous Protrusion after a Ventriculo-peritoneal Shunting

一個罕見的腦室腹腔引流手術自腹腔穿出皮膚的併發症。六十五歲男性被發現腦室腹腔引流管自腹腔穿出皮膚。腹腔引流管自胸腔皮膚被移出腹腔，並且建立腦脊髓液引流系統。同時使用抗生素六周。在腦脊髓液細菌培養不再長出細菌之後進行腦室腹腔引流重置手術。腦室腹腔引流重製手術將在腦脊髓液細菌培養不再長出細菌之後進行。長期臥床、糖尿病、營養不良與引流管管路放置不良是這樣併發症的可能原因。腦脊髓液引流系統可以減少多次腦室腹腔引流重置手術並為引流管感染治療的選擇。

To report the rare occurrence of a ventriculoperitoneal shunt spontaneously protruding out of the peritoneal cavity through the skin. A 65-year-old patient, who had a history of diabetes and hypertension, presented diffused subarachnoid hemorrhage and acute hydrocephalus, for which ventriculopertoneal shunt surgery was performed. Later, the patient was found to have the shunt protruding from the peritoneal cavity out to the skin and a shunt infection. The distal end of the peritoneal catheter was used to perform extraventricular drainage (EVD) through the chest wall, and the patient was adminstered antibiotics for 6 weeks. No intrathecal antibiotics were used. After the patient was found to be free of bacteria growth by CSF culture, shunt revision was performed. This rare complication was caused by long-term immobilization, DM, malnutrition and malposition of distal end of peritoneal catheter. EVD decreased the chance of shunt revision and found to be a good choice for shunt infection treatment.