摘要目的 探索脑积水脑室-腹腔(V -P)分流术的改进方法,以提高疗效、降低并发症.方法 解剖研究尸体大网膜成人16例、儿童12例,普外腹腔镜手术中观测大网膜下缘位置.95例脑积水患者脑室端CT定位确定穿刺点和深度,在腹腔镜和特制微创腹腔穿刺置管器协助下行左下腹穿刺将分流管腹腔端置于盆腔无大网膜区.结果 成人尸体大网膜上腹型和中腹型占81.3％；儿童无下腹型.临床病例随访3-45个月,Salmon's分级,有效率95.7％,并发症9例(9.5％):感染3例、梗阻5例、不明原因气颅1例.结论 微创V-P分流术治疗脑积水临床疗效满意度高,实用性强.

abstractsObjective To explore a new approach for improving therapeutic effects and minimizing complications of ventriculoperitoneal shunt (VPS).Methods The length of and lower edge of the greater omentum were measured and analyzed in 28 autopsies (16 adults and 12 children) and laparoscopic surgeries.95 cases of hydrocephalus treated by MIVPS( minimally invasive ventriculoperitoneal shunt) were retrospectively reviewed.The depth and positions of puncture into ventricles were confirmed by CT scanning.And then distal ventriculoperitoneal shunt was navigated into left pelvic area by the assistance of laparoscopy and the special abdominal puncture device.Results The findings of autopsies demonstrated that the percentage of upper and middle abdominal types of greater omentum position was 81.3％ in adults.There was no lower abdominal type in children.These cases were followed up from 3 to 45 months.The Salmon' s classification rate was 95.7％.Complications were found in 9 cases ( 9.5％ ):infection in 3 cases (3.2％),obstruction in 5 cases (5.3％),and 1 case of unknown pneumocephalus (1.0％).Conclusions MIVPS is better than previous VPS.It is helpful to reduce complications and should be considered for advanced clinical application.