Suprahepatic spaceへの脳室腹腔シャント腹腔端の再建

Peritoneal Catheter Placement into the Suprahepatic Space: A Report of 2 Cases with Abdominal Complications of Ventriculoperitoneal Shunts

Ⅰ．はじめに

　脳室腹腔シャント（VP shunt）術後の腹腔端閉塞の頻度は1.1～19％と報告されており^{2,3,5,6,8,13-15)}，決して稀ではない．閉塞が非感染性要因であれば，遠位端の腹腔内への再挿入によるシャント再建術，もしくは脳室心房シャント術が次の手術として選択されることが多い．しかしながら感染性要因による腹腔端閉塞や重篤な全身感染症を併発している症例では，遠位端の留置部位選択に難渋する．

　最近経験した腹腔内合併症によるシャント機能不全を繰り返す成人水頭症の2症例において，代替の遠位端留置ルートとして肝臓上面，すなわち右横隔膜下の腹膜腔であるsuprahepatic spaceを選択した．Suprahepatic spaceへの腹腔端再建の手技は通常の腹腔端再建術の延長線上にあり，新たな遠位端留置先として有用な選択肢と考えられたので報告する．

　Complications arising from the placement of ventriculoperitoneal shunts are common. These complications may be related to a number of causes and present with various symptoms. Of these,abdominal complications such as formation of intraperitoneal pseudocysts and abdominal abscesses possibly recur,but,alternative sites for placing the peritoneal catheter of ventriculoperitoneal shunts are limited. We present two cases of ventriculoperitoneal shunt malfunctioning due to repeated abdominal complications. The location of the peritoneal end of the shunt was successfully revised to the suprahepatic space in the peritoneal cavity. We describe the clinical course of these two cases in this report,along with a precise technique of placing the peritoneal end of the shunt into the suprahepatic space. In addition,we will discuss the validity of this space as an alternative site for the placement of the peritoneal end of the ventriculoperitoneal shunt.