腹腔鏡による遊離脳室腹腔シャントカテーテルの摘出

Laparoscopic retrieval of a dislocated ventriculoperitoneal shunt catheter:report of three cases and a review of the literature

I．はじめに

　脳室腹腔シャント術後におけるシャント再建率は，小児で51-61％^{6,8,12,17,18）}，成人では28-37％^6,8）であり，シャントカテーテルの離断によるシャント不全が15％^1）と報告されている．離断したカテーテルは腹腔内に遊離して細菌感染や臓器癒着を引き起こし，髄液吸収の腹膜有効面積を減少させる^{7,10,11,13,18）}．また，カテーテルが陰嚢内^9,19）や消化管^9,19）に迷入した急性腹症例も報告されており，早期に遊離カテーテルを摘出することが望ましい．

　最近，遊離カテーテルを腹腔鏡で摘出し得た3症例を経験したので，文献的考察を加えて報告する．

Described are 3 cases of a disconnected ventricu-loperitoneal shunting system that was successfully re-trieved by using a laparoscopic procedure, with a re-view of the literature. All patients had symptoms of in-creased intracranial pressure. Roentgenograms showed disconnection of a ventriculoperitoneal shunt catheter at the connecting device and its migration into the peri-toneal cavity. A laparoscope was introduced into the peritoneal cavity using the double puncture procedure and the catheter was extracted in less than 15 minutes.The use of a laparoscope enabled exploration of the en-tire space of the cavity without any large laparotomy incision. Furthermore, the laparoscopic procedure also easily enabled introduction of a replaceable ventricu-loperitoneal shunt catheter into the appropriate portion in the cavity and confirmed the CSF flow into the cav-ity. Because catheters which have migrated into the cavity might cause an acute abdomen, it is important that they should be removed as soon as possible. It should be kept in mind, during the procedures of ex-tracting catheters, that the inner absorptive surface of the peritoneal cavity must be preserved as much as possible. In this regard, laparoscopic retrieval of discon-nected shunt catheters is a promising method.