CAJ | 학술논문

目的：探讨持续腰椎穿刺引流术在高位骶骨肿瘤切除术后脑脊液漏患者中的应用效果。方法采用回顾性对比分析方法。对1998年1月至2011年8月，就诊于我科行高位骶骨肿瘤切除术并有完整病例资料的72例进行分析。纳入标准为：骶骨肿瘤切除患者术中发生硬脊膜损伤且术后发生脑脊液漏的患者，同时排除有持续腰椎穿刺脑脊液引流禁忌证如脑疝、颅内压明显增高、穿刺部位皮肤或软组织感染、全身严重感染败血症或休克、穿刺不能合作、L3以上脑脊液循环通路梗阻等情况的患者。最终符合纳入标准共11例。将2005年3月前行骶骨肿瘤切除术后发生脑脊液漏患者使用单纯伤口旁放置引流管引流的5例作为对照组，2005年3月以后行骶骨肿瘤切除术后发生脑脊液漏的6例为采用持续腰椎穿刺引流治疗组，分别对两组患者脑脊液漏治愈时间和患者一般情况及相关并发症进行对比研究。结果两组患者均无逆行性颅内感染发生，其中单纯放置引流管引流组1例发生手术切口局部感染。持续腰椎穿刺引流患者脑脊液漏愈合时间中位数为14.5(12～18)天，较对照组患者25(23～36)天缩短，两组差异有统计学意义( P＝0.004)。腰椎穿刺引流组患者治疗期间骶尾部切口渗液少，肿胀明显较单纯引流组轻，患者自体感觉如伤口疼痛、头晕等症状较单纯引流组轻。两组患者均无低颅压性头痛、无进行性低颅压、气颅、脑疝等并发症发生。结论持续腰椎穿刺引流治疗骶骨肿瘤切除术后脑脊液漏较单纯伤口旁引流效果好，并且有效缩短脑脊液瘘口闭合时间。
목적：탐토지속요추천자인류술재고위저골종류절제술후뇌척액루환자중적응용효과。방법채용회고성대비분석방법。대1998년1월지2011년8월，취진우아과행고위저골종류절제술병유완정병례자료적72례진행분석。납입표준위：저골종류절제환자술중발생경척막손상차술후발생뇌척액루적환자，동시배제유지속요추천자뇌척액인류금기증여뇌산、로내압명현증고、천자부위피부혹연조직감염、전신엄중감염패혈증혹휴극、천자불능합작、L3이상뇌척액순배통로경조등정황적환자。최종부합납입표준공11례。장2005년3월전행저골종류절제술후발생뇌척액루환자사용단순상구방방치인류관인류적5례작위대조조，2005년3월이후행저골종류절제술후발생뇌척액루적6례위채용지속요추천자인류치료조，분별대량조환자뇌척액루치유시간화환자일반정황급상관병발증진행대비연구。결과량조환자균무역행성로내감염발생，기중단순방치인류관인류조1례발생수술절구국부감염。지속요추천자인류환자뇌척액루유합시간중위수위14.5(12～18)천，교대조조환자25(23～36)천축단，량조차이유통계학의의( P＝0.004)。요추천자인류조환자치료기간저미부절구삼액소，종창명현교단순인류조경，환자자체감각여상구동통、두훈등증상교단순인류조경。량조환자균무저로압성두통、무진행성저로압、기로、뇌산등병발증발생。결론지속요추천자인류치료저골종류절제술후뇌척액루교단순상구방인류효과호，병차유효축단뇌척액루구폐합시간。
Objective To investigate the application effects of continuous lumbar puncture drainage in the treatment of patients with cerebrospinal lfuid ( CSF ) leakage after superior sacral tumor resection. Methods A retrospective and comparative study was conducted to review 72 patients who underwent superior sacral tumor resection and had complete medical records from January 1998 to August 2011. The inclusive criteria were that the patients with dural injuries during sacrum tumor resection had CSF leakage postoperatively, meanwhile excluding those who had contraindications after continuous lumbar puncture CSF drainage such as brain hernia, intracranial pressure increased obviously, skin or soft tissue infection in puncture position, systemic inflammatory response syndrome ( SIRS ) to severe sepsis or septic shock, not cooperating puncture, CSF circulation channel obstruction above L3 etc. 11 patients were in accordance with the inclusive criteria ifnally. 5 patients with CSF leakage after sacrum tumor resection who underwent single drainage using a tube beside the wound before March 2005 were taken as the control group. While the other 6 patients who had CSF leakage after sacrum tumor resection after March 2005 were taken as the continuous lumbar puncture drainage group. The healing time of CSF leakage, the general condition of patients and related complications were compared between the 2 groups. Results No retrograde intracranial infection occurred in both groups, while 1 patient in the control group had local infection of operative incision. The healing time of the patients in the continuous lumbar puncture drainage group was at a median of 14.5 days ( range;12-18 days ), while 25 days ( range;23-36 days ) in the control group, and there were statistically signiifcant differences between them ( P=0.004 ). Less oozing or swelling appeared in the operative incision of the sacrococcygeal region of the continuous lumbar puncture drainage group during the treatment than that of the control group. At the same time, self-feelings of patients in the continuous lumbar puncture drainage group, such as wound pain, dizziness symptoms and so on, were lighter than that of the control group. No patients in both groups had complications such as low intracranial pressure headache, progressive low intracranial pressure, intracranial pneumatosis, cerebral hernia, etc. Conclusions Continuous lumbar puncture drainage can achieve better results than single drainage beside the wound in the treatment of patients with CSF leakage after sacral tumor resection, which can effectively shorten the closure time of CSF ifstula.