目的：分析难治性脑积水患者反复脑室腹腔分流术（ VP）失败后改脑室心房分流术（ VA）的临床治疗情况。方法收集我院收治的反复VP失败后改行VA的脑积水患者，回顾分析其治疗情况和预后；同时利用logistic回归分析年龄、性别、术前是否感染、术前手术次数、以及术侧与VA手术的成败是否相关。结果共入选46例患者，其中首次VA成功的占73．9％（34/46），首次失败的占26．1％（12/46），失败原因包括感染、静脉血栓、分流管心房端移位等。 logestic回归分析显示年龄、性别、术前是否感染、术前手术次数、术侧与首次VA手术的成败不相关。首次失败后的有12例患者，经过重新手术后成功的58．3％（7/12）；经再手术仍然失败并且最终死亡的占41．7（5/12），原因为感染和肺动脉高压。结论 VA治疗反复VP失败的脑积水患者仍然具有较高的成功率；但首次VA失败后，再失败的机率高，预后差。%Objective To analyze the clinical outcome of ventriculoatrial shunt ( VA ) shunt converted from multiple failure of ventriculoperitoneal shunt ( VP ) shunt for the refractory hydrocephalus patients .Methods Retrospectively analyze the treatment and outcome of the VA shunt patients after multiple failure of VA shunt .And the datas were also collected and analyzed to see whether age, gender, infection, times of previous operation, operative side are any associated with the outcome of the VA shunt operation .Results There were 46 eligible patients , among which 73.9%(34/46) succeeded and 26.1%(12/46) failed after the first time of VA shunt for these group of patients .Reasons for the failure included infection , venous embolization , displaced distal catheter and so on so forth .Outcomes of the operation were not related to any of the factors including age, gender, infection, times of previous operation , operative side.12 patients failed after the first VA Shunt.Future Success were achieved in 58.3%(7/12) of them.41.7%(5/12) of the patients died.4 were because of sever infection and 1 was because of pulmonary artery hypertension . Conclusion VA is effective for the refractory hydrocephalus patient after multiple failure of VA shunt;but the rate of failure is high after the failure of first VP shunt and the result could be devastating .
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