脊柱外科杂志
脊柱外科雜誌
척주외과잡지
JOURNAL OF SPINE SURGERY
2014年
5期
309-312
,共4页
孔金海%肖辉%孙正望%刘铁龙%严望军%宋滇文%钟南哲%缪吴军%杨建%王静%杨兴海%肖建如
孔金海%肖輝%孫正望%劉鐵龍%嚴望軍%宋滇文%鐘南哲%繆吳軍%楊建%王靜%楊興海%肖建如
공금해%초휘%손정망%류철룡%엄망군%송전문%종남철%무오군%양건%왕정%양흥해%초건여
腰椎%脊柱肿瘤%硬膜下积液%蛛网膜下腔%引流术
腰椎%脊柱腫瘤%硬膜下積液%蛛網膜下腔%引流術
요추%척주종류%경막하적액%주망막하강%인류술
Lumbar vertebrae%Subarachnoid space%Spinal neoplasms%Subdural effusion%Drainage
目的：探讨腰大池引流术在脊柱肿瘤硬膜囊缺损合并难治性脑脊液漏患者中的应用价值。方法回顾性分析本院2005年1月～2012年12月收治的84例脊柱肿瘤硬膜缺损合并难治性脑脊液漏的患者，行持续性腰大池引流术，观察患者术后即刻，术后1周，术后3周时体温变化；术前、术后1周，术后3周时白细胞、血沉，C-反应蛋白的变化。术后3d、1周，3周内脑脊液量变化的情况。结果实施腰大池引流术后，患者体温、白细胞、血沉、C－反应蛋白出现先升高，随着治疗的进行而逐渐下降恢复为正常水平。放置腰大池引流前，患者脑脊液引流量为135～670 mL/d，平均356 mL/d；术后3周时，多数患者引流量已经降至正常。腰大池引流的放置时间13～25 d，平均16．3 d。腰大池引流中发生引流过度4例、引流不畅3例、引流管滑脱1例，经过调整引流速度，冲洗疏通管腔，适时缝闭皮缘达到满意效果。至末次随访时，原伤口中1例出现皮肤发红，1例发生局部血肿，1例伤口愈合不佳，1例伤口渗液，其余患者均取得了较良好的引流效果，并实现顺利拔除原伤口引流管。结论脊柱肿瘤中多数硬膜囊缺损无法完全缝合修补。对伴有难治性脑脊液漏患者采取降低局部脑脊液压力的持续性腰大池引流术，对促进硬膜的修复和预防并发症的发生有显著的效果。
目的：探討腰大池引流術在脊柱腫瘤硬膜囊缺損閤併難治性腦脊液漏患者中的應用價值。方法迴顧性分析本院2005年1月～2012年12月收治的84例脊柱腫瘤硬膜缺損閤併難治性腦脊液漏的患者，行持續性腰大池引流術，觀察患者術後即刻，術後1週，術後3週時體溫變化；術前、術後1週，術後3週時白細胞、血沉，C-反應蛋白的變化。術後3d、1週，3週內腦脊液量變化的情況。結果實施腰大池引流術後，患者體溫、白細胞、血沉、C－反應蛋白齣現先升高，隨著治療的進行而逐漸下降恢複為正常水平。放置腰大池引流前，患者腦脊液引流量為135～670 mL/d，平均356 mL/d；術後3週時，多數患者引流量已經降至正常。腰大池引流的放置時間13～25 d，平均16．3 d。腰大池引流中髮生引流過度4例、引流不暢3例、引流管滑脫1例，經過調整引流速度，遲洗疏通管腔，適時縫閉皮緣達到滿意效果。至末次隨訪時，原傷口中1例齣現皮膚髮紅，1例髮生跼部血腫，1例傷口愈閤不佳，1例傷口滲液，其餘患者均取得瞭較良好的引流效果，併實現順利拔除原傷口引流管。結論脊柱腫瘤中多數硬膜囊缺損無法完全縫閤脩補。對伴有難治性腦脊液漏患者採取降低跼部腦脊液壓力的持續性腰大池引流術，對促進硬膜的脩複和預防併髮癥的髮生有顯著的效果。
목적：탐토요대지인류술재척주종류경막낭결손합병난치성뇌척액루환자중적응용개치。방법회고성분석본원2005년1월～2012년12월수치적84례척주종류경막결손합병난치성뇌척액루적환자，행지속성요대지인류술，관찰환자술후즉각，술후1주，술후3주시체온변화；술전、술후1주，술후3주시백세포、혈침，C-반응단백적변화。술후3d、1주，3주내뇌척액량변화적정황。결과실시요대지인류술후，환자체온、백세포、혈침、C－반응단백출현선승고，수착치료적진행이축점하강회복위정상수평。방치요대지인류전，환자뇌척액인류량위135～670 mL/d，평균356 mL/d；술후3주시，다수환자인류량이경강지정상。요대지인류적방치시간13～25 d，평균16．3 d。요대지인류중발생인류과도4례、인류불창3례、인류관활탈1례，경과조정인류속도，충세소통관강，괄시봉폐피연체도만의효과。지말차수방시，원상구중1례출현피부발홍，1례발생국부혈종，1례상구유합불가，1례상구삼액，기여환자균취득료교량호적인류효과，병실현순리발제원상구인류관。결론척주종류중다수경막낭결손무법완전봉합수보。대반유난치성뇌척액루환자채취강저국부뇌척액압력적지속성요대지인류술，대촉진경막적수복화예방병발증적발생유현저적효과。
Objective To evaluate the application of lumbar subarachnoid drainage with dura reparation in spinal tumor with refractory cerebrospinal fluid leakage .Methods From January 2005 to December 2012, 84 cases with refractory cerebro-spinal fluid leakage were retrospectively analyzed .All patients received lumbar subarachnoid drainage .Temperature were observed at postoperative immediately , 1 week and 3 weeks after operation .And the leucocyte , blood sedimentation , and the change of C-reactive protein ( CRP) were observed at preoperative , 1 week and 3 weeks after operation .The changes of cere-brospinal fluid were observed at 3 d, 1 week and 3 weeks after operation .Results The temperature, leucocyte, blood sedi-mentation and CRP were raised after the lumbar subarachnoid drainage , then dropped back to normal with treatment continu-ous.The cerebrospinal fluid volume was 135-670 mL/d ( average 356 mL/d) before lumbar subarachnoid drainage , and most of patients’ dropped to normal in 3 weeks after the operation .The average drainage time was 16.3 d.Until to final follow-up, 4 cases had excessive drainage , 3 cases had poor drainage and 1 case had drainage tube slippage .One case occurred skin red-ness, 1 case had poor wound healing , 1 case had wound effusion , and the remaining patients were achieved good drainage effect and the original wound drainage tubes were removed .Conclusion Dura reparation is a good choice for spinal tumor with dura defect which can not be sutured .For patients with a huge amount of cerebrospinal fluid drainage , lumbar subarach-noid drainage is a reliable and effective treatment , and it ’ s good to promote epidural reparation and prevent complications occurrence .
