CAJ | 학술논문

目的：探讨应用医用胶联合明胶海绵修补硬脊膜预防脑脊液漏的临床疗效。方法回顾性分析2007年1月至2014年10月宜春市人民医院收治的96例椎管内硬脊膜下肿瘤患者资料，根据硬脊膜修复方法不同将患者分成两组。医用胶联合明胶海绵组51例（实验组），男27例，女24例；年龄24～68岁。明胶海绵组45例（对照组），男23例，女22例；年龄21～70岁。患者在切除椎管内硬脊膜下的肿瘤后，对照组缝合硬脊膜后，用明胶海绵加以覆盖。实验组缝合硬脊膜后，医用胶喷涂缝合口，然后覆盖明胶海绵，最后在明胶海绵表面喷涂医用胶。分析两组患者临床资料，观察患者切口愈合情况及其相关并发症。结果实验组术后引流量较对照组明显下降（P=0.01）。两组患者手术时间、术中出血量、硬脊膜切口长度、引流时间及住院时间差异均无统计学意义（P>0.05）。实验组9例、对照组16例发生脑脊液漏，两组脑脊液漏发生率比较差异有统计学意义（P=0.03）。对照组在引流管拔除后7～10 d仍有5例出现切口积液，经穿刺抽液、沙袋加压、俯卧体位等治疗后切口愈合。所有患者术后切口均甲级愈合，无延迟愈合、感染等相关并发症发生。两组患者均获得随访，随访时间12～72个月。对照组3个月时仍有4例患者B超检查示深部积液。结论应用医用胶联合明胶海绵修补硬脊膜可明显提高缝合修复效果，减少术后引流量，降低脑脊液漏发生率。
목적：탐토응용의용효연합명효해면수보경척막예방뇌척액루적림상료효。방법회고성분석2007년1월지2014년10월의춘시인민의원수치적96례추관내경척막하종류환자자료，근거경척막수복방법불동장환자분성량조。의용효연합명효해면조51례（실험조），남27례，녀24례；년령24～68세。명효해면조45례（대조조），남23례，녀22례；년령21～70세。환자재절제추관내경척막하적종류후，대조조봉합경척막후，용명효해면가이복개。실험조봉합경척막후，의용효분도봉합구，연후복개명효해면，최후재명효해면표면분도의용효。분석량조환자림상자료，관찰환자절구유합정황급기상관병발증。결과실험조술후인류량교대조조명현하강（P=0.01）。량조환자수술시간、술중출혈량、경척막절구장도、인류시간급주원시간차이균무통계학의의（P>0.05）。실험조9례、대조조16례발생뇌척액루，량조뇌척액루발생솔비교차이유통계학의의（P=0.03）。대조조재인류관발제후7～10 d잉유5례출현절구적액，경천자추액、사대가압、부와체위등치료후절구유합。소유환자술후절구균갑급유합，무연지유합、감염등상관병발증발생。량조환자균획득수방，수방시간12～72개월。대조조3개월시잉유4례환자B초검사시심부적액。결론응용의용효연합명효해면수보경척막가명현제고봉합수복효과，감소술후인류량，강저뇌척액루발생솔。
ObjectiveTo investigate the therapeutic effect of the cyanoacrylates combined with gelatin sponge in the repair of spinal dura mater to prevent the cerebrospinal lfuid leakage.MethodsFrom January 2007 to October 2014, 96 patients with spinal subdural tumors underwent excision of tumor in our hospital. According to the manner of repairing spinal dura mater, all patients were classiifed into two groups: control group and the experimental group. There were 23 males and 22 females with an average age of (45.3±6.1) years in the control group. While 27 males and 24 females with all average age of (43.6± 5.7) years in experimental group.In control group, the spinal dura mater was repaired through running locked suture. In experimental group, the spinal dura mater was repaired through running locked suture, painting medical glue around the dural incision, coveting with gelatin sponge, and painting medical glue on the surface and margin of gelatin sponge successively.The ratios of watertight closure,incision healing and relative complications were compared between the two groups.ResultsCompared with the control group,the total volume of postoperative drainage in experimental group decreased signiifcantly and the incidence of cerebrospinal lfuid leakage decreased signiifcantly(P=0.01).There was no signiifcant difference in operation time, blood loss, length of dura incision, hospitalization time and drainage time between the two groups(P>0.05).The ratios of cerebrospinal lfuid leakage of the trial and control groups were 17.6% and 35.6% respectively,showing signiifcant difference(P=0.03). Before discharge, hydrops happened in 5 cases in the control group and got well through aspiration, continuous pressure by sandbag and prone position. Primary incision healing was obtained, no delayed healing and infection occurred in all patients. Three months after operation,4 cases from the control group got deep hydrops under the incision.ConclusionThe method of cyanoacrylates combined with gelatin sponge can improve the repair effect of spinal dura mater injury, reduce the volume of postoperative drainage and decrease the incidence of cerebrospinal lfuid leakage.