Clinical Value Of Lumboperitoneal Shunt In Treatment Of Communicating Hydrocephalus

Objective : By comparing the postoperative curative effect and incidence of complications of Lumboperitoneal shunt and Ventriculoperitoneal shunt surgery for communicating hydrocephalus, such as blocking pipe, epilepsy, intracranial hemorrhage, infection, excessive diversion, nerve root pain, distal complications and diversion tube shift, etc, to explore the clinical application value of the lumboperitoneal shunt surgery for communicating hydrocephalus. Method: 40 cases of communicating hydrocephalus were treated by the Anqing hospital of anhui medical university from January 2014 to July 2015.All of them signed the informed consent form. Detailed and careful preparation should be done before the operation,with the operation indication clear and no surgical contraindications. Thereinto,20 patients accepted LPS and 20 patients accepted VPS. In this research,retrospective analysis were used to compare the therapeutic effects and the incidence of postoperative complications for any significant differences.We judged the curative effect by the changes of ratio of ventricle diameter and biparietal diameter(the change of ventricle), mini-mentalstste examination scale(MMSE scale), three minutes walking experiment(observation stride length and gait speed), International Consultation on Incontinence Questionnaire short form score(ICI- Q- SF).We drew a conclusion by statistically analysing the minification of postoperative ventricle, the change of MMSE scale,the improvement rate of gait and urinary incontinence and the incidence of complications,shunt pipe plugging, postoperative infection, epilepsy, intracranial hemorrhage, excessive diversion, nerve root pain, distal complications, tube shift included,using chi-square test or fisher’s exact probability method. Results:There was no statistically significant difference between two groups,who used Lumboperitoneal shunt and Ventriculoperitoneal shunt respectively,in therapeutic effects(P > 0.05),such as the minification of postoperative ventricle(85% vs 80%), the change of MMSE scale(60% vs 64.3%), gait improvement rate(55.6% vs 61.1%) and urinary incontinence improvement rate(50.0% vs 70.0%).The incidence of complications of lumboperitoneal shunt, like epilepsy(0 vs 35%),infection(5% vs35%),intracranial hemorrhage(0 vs 30%),proximal obstruction(5%vs 40%) and so on was significantly lower than that of ventriculoperitoneal shunt(P<0.05, for all).While the incidence of excessive diversion of LPS group(35% vs 5%) was higher than that of VPS group(P < 0.05), no statistical difference in the incidence of nerve root pain, distal complications, and tube shift between the two groups(P > 0.05). In LPS group, elderly patients with normal pressure hydrocephalus and skull defect-free patients reduced the incidence of excessive diversion, 9.1% and 8.3% respectively. Conclusion:The Ventriculoperitoneal shunt applies to all patients with hydrocephalus, adapt to a wider range, more common clinical application,but the incidence of serious complications,which contain shunt pipe plugging, postoperative infection, epilepsy, intracranial hemorrhage is high. Lumboperitoneal shunt can be recommended for the treatment of patients with communicating hydrocephalus because of its minimal invasiveness,lower rate of the lethal complications and satisfying clinical curative effect. The nerve root pain and excessive diversion after adjustment can be improved. Skull defect and activity can effect the incidence of excessive diversion more or less.