CAJ | 학술논문

目的：评价单纯更换切口敷料、延长引流管留置时间和延长引流时间并间断夹闭引流管3种方法对腰椎术后脑脊液漏的治疗效果。方法37例术后出现脑脊液漏患者，13例采用术后3 d拔除切口引流管及更换切口敷料治疗（A组），12例采用延长引流时间治疗（B组），12例采用延长引流时间并间断夹闭引流管治疗（C组）。对3种治疗方法的疗效和并发症进行评价。结果 A 组脑脊液漏消失时间为（20.38±2.53） d，切口愈合时间为（24.46±4.31） d，其中6例初期治疗切口愈合，术后平均（19.01±3.16） d脑脊液漏消失；7例初期治疗失败，均行二次手术，术后平均（16.57±0.97）d脑脊液漏消失。B 组脑脊液漏的消失及引流的平均时间为（9.27±1.10） d，切口均一期愈合，愈合时间为（17.17±1.19）d，未出现脊膜炎和切口感染。C组脑脊液漏的消失及引流的平均时间为（8.58±1.44）d，切口均一期愈合，愈合时间为（16.91±1.37）d，无感染等并发症。对A、B、C3组脑脊液漏消失时间及切口愈合时间进行多重比较t检验，可得出A组与B组、A组与C组，P值=0.000，P均＜0.001，按α=0.05水准，差异均有统计学意义。而B组与C组脑脊液漏消失时间P值=0.377，切口愈合时间P值=0.857，P均>0.05，按α=0.05水准，差异无统计学意义。结论延长术区引流时间和结合间断夹闭引流管是治疗脊柱手术后脑脊液漏的有效方法，单纯更换切口敷料治疗效果较差且并发症较多。
목적：평개단순경환절구부료、연장인류관류치시간화연장인류시간병간단협폐인류관3충방법대요추술후뇌척액루적치료효과。방법37례술후출현뇌척액루환자，13례채용술후3 d발제절구인류관급경환절구부료치료（A조），12례채용연장인류시간치료（B조），12례채용연장인류시간병간단협폐인류관치료（C조）。대3충치료방법적료효화병발증진행평개。결과 A 조뇌척액루소실시간위（20.38±2.53） d，절구유합시간위（24.46±4.31） d，기중6례초기치료절구유합，술후평균（19.01±3.16） d뇌척액루소실；7례초기치료실패，균행이차수술，술후평균（16.57±0.97）d뇌척액루소실。B 조뇌척액루적소실급인류적평균시간위（9.27±1.10） d，절구균일기유합，유합시간위（17.17±1.19）d，미출현척막염화절구감염。C조뇌척액루적소실급인류적평균시간위（8.58±1.44）d，절구균일기유합，유합시간위（16.91±1.37）d，무감염등병발증。대A、B、C3조뇌척액루소실시간급절구유합시간진행다중비교t검험，가득출A조여B조、A조여C조，P치=0.000，P균＜0.001，안α=0.05수준，차이균유통계학의의。이B조여C조뇌척액루소실시간P치=0.377，절구유합시간P치=0.857，P균>0.05，안α=0.05수준，차이무통계학의의。결론연장술구인류시간화결합간단협폐인류관시치료척주수술후뇌척액루적유효방법，단순경환절구부료치료효과교차차병발증교다。
ObjectiveTo discuss and examine the operational effects of three methods of simple replace incision dressing、extending duration of indweling drainage tube for incision and extended operational drainage time and intermittent drainage tube-champing for cerebrospinal fluid leakage after surgery. Methods37 patients with leakage of cerebrospinal fluid after spinal surgery, Applying antibiotics before the wound healed in three groups. 13 cases had applied simple replace incision dressing after the routine wound dressing and 3 d (Group A), 12 cases adopted the extending duration of indweling drainage tube for incision and intermittent drainage tube-champing (Group B), 12 cases had extended operational drainage time and intermittent drainage tube-champing (Group C). Examining the effects and related complication of these three treatment after lumbar spine surgery.ResultsIn Group A, cases’s wound had been healed in (24.46±4.31)d,the cerebrospinal fluid leakage had ceased in (20.38±2.53)d, 6 cases among had been healed in primary stage of treatment, ceased within (19±3.16)d; 7 cases had failed to respond, with dural repairing, ceased in (16.57±0.97)d; The cerebrospinal fluid leakage for Group B patients had ceased in(9.27±1.10)d, skin incision had stage I heal, healed in (17.7±1.19)d, had no spinal meningitis and incision infection. Patients in Group C had been ceased in 8.58±1.44 d after drainage, with stage I heal, healed in (16.91±1.37) d, no related complication and incision infection. Using the multiple comparison T test for Group A, Group B, and Group C, there is statistical significance among groups (P value =0.000,P<0.001,α=0.05 level). While the Group B and Group C, the cerebrospinal fluid leakage disappeared time,P=0.377, wound healing time,P value =0.857,P>0.05,α=0.05 level, there is no significant difference between groups. Conclusion Extended operational drainage time and intermittent drainage tube-champing is an effective treatment for cerebrospinal fluid leakage after lumbar spine surgery. Conventional treatment of incision dressing is less effective and with more related complication.