【摘要】 目的:评价单纯更换切口敷料、术区持续引流和经皮蛛网膜下腔引流对脊柱术后脑脊液漏的治疗效果。方法:2003年1月～2008年6月我科实施脊柱手术2481例,术后44例出现脑脊液漏,其中男29例,女15例,年龄25～65岁,平均49.1岁。在切口愈合前应用抗生素预防感染,同时分别进行单纯更换切口敷料(A组,19例)、延长术区引流时间(B组,19例)、腰部经皮蛛网膜下腔脑脊液引流(C组,6例),对3种治疗方法的疗效和并发症进行评价。结果:A组中9例(47.4%)切口愈合,术后平均16.8d脑脊液漏消失,其中3例合并假性硬膜囊肿;10例(52.6%)治疗失败,其中4例1周内脑脊液漏出无减少趋势,3例行单纯硬膜修补,脑脊液漏于术后14d消失,1例行蛛网膜下腔引流后当日脑脊液漏消失,5例(26.3%)合并脊膜炎,经蛛网膜下腔引流和注入抗生素,脑脊液漏于置管当日消失,3d后治愈,1例(5.3%)合并切口感染。假性硬膜囊肿和切口感染者采用直接硬膜修补和经皮蛛网膜下腔引流均获得治愈,蛛网膜下腔引流后第1日脑脊液漏消失。B组脑脊液漏的消失及引流的平均时间为7.2d,切口均Ⅰ期愈合,未出现脊膜炎和切口感染。C组引流后平均1.8d脑脊液漏消失,平均引流时间为6.9d,切口均Ⅰ期愈合,无感染等并发症。结论:延长术区引流时间和经皮蛛网膜下腔引流是治疗脊柱手术后脑脊液漏的有效方法,单纯更换切口敷料效果较差、并发症较多。更多还原

【Abstract】 Objective:To assess the clinical effect of skin incision dressing changing alone,prolonging wound drainage and percutaneous subarachnoid cerebrospinal fluid(CSF)drainage on postoperative CSF leakage.Method:From January 2003 to June 2008,a total of 2481 patients underwent spinal surgery in our depart-ment,and 44 cases(male 29,female 15)aged from 25 to 65 years(mean 49.1 years)were complicated with CSF leakage after operation.Patients in group A(n=19)were administered rational antibiotics prophetically and received only changing wound dressings;patients in group B(n=19)underwent prolonging wound drainage,and patients in group C(n=6)underwent lumbar percutaneous subarachnoid CSF drainage.These three treating pro-tocols in terms of effectiveness and complication were evaluated retrospectively.Result:In group A,only 9 cas-es(47.4%)acquired wound healing,the average CSF leakage duration was 16.8 days postoperatively,and 3 cases were complicated with pseudomeningocele.10 cases(52.6%)failed and necessitated additional manage-ment.Of these,4 cases failed the tendency of CSF leakage decreasing,and herein,single dural repair was per-formed in 3 cases and CSF leakage ceased 14 days after repairing,subarachnoid drainage was performed in 1 case and CSF leakage ceased within the day of drainage.5 cases(26.3%)were complicated with spinal meningitis,which resolved after 3 days of subarachnoid CSF drainage and administration of antibiotics,the CSF leakage ceased within the day of drainage.1 case(5.3%)was complicated with wound infection.Cases with pseudomeningocele or wound infection acquired wound healing following the treatments of dural repair and percutaneous subarachnoid CSF drainage,and CSF leakage ceased within the next day following drainage.In group B,the average duration of CSF leakage and drainage was 7.2 days.All cases acquired primary wound healing without spinal meningitis and wound infection.In group C,the average period of CSF leakage was 1.8 days,and the average drainage period was 6.9 days.All cases acquired primary wound healing without any in-fections.Conclusion:Prolonging wound drainage and percutaneous subarachnoid CSF drainage are effective and initial treatments for the postoperative CSF leakage,while wound dressing changing alone has poor outcome and more complications.更多还原