【摘要】 目的探讨腰骶椎管手术中行腰大池置管的方法及其预防腰骶椎管手术后脑脊液漏的效果。方法回顾性分析解放军总医院神经外科2015年8月至2015年10月23例行腰骶椎管手术中硬膜修补困难患者的临床资料,按术中是否放置腰大池引流分为观察组(11例)和对照组(12例),术后控制引流,硬脊膜基本愈合后拔除硬脊膜外引流,7~10 d后拔除腰大池引流,记录硬脊膜外引流留置的时间,并进行统计分析。结果观察组硬脊膜外引流拔除时间明显早于对照组,差异有统计学意义(P<0.05),观察组患者术后可能存在短期并发症,但感染率未见明显增加。结论术中行腰大池置管可有效解决腰骶椎管手术后放置腰大池置管困难的问题,降低腰骶椎管手术后脑脊液漏的风险。但无论何种引流,均无法替代精细的手术操作和严密的硬脊膜缝合,只能作为硬脊膜修补失败的补救措施。更多还原

【Abstract】 Objective To study the technique of lumbar cathetering in lumbosacral vertebral canal operation and its effect on prevention of postoperative cerebrospinal fluid leakage. Methods Retrospectively analyzed the clinical data of patients who underwent lumbosacral vertebral canal surgery and suffered from difficult dural repair during the operation in Department of Neurosurgery from August 2015 to October2015. These patients were divided into the observation group(11 cases) and the control group(12 cases) according to whether lumbar catheter were placed during the operation or not. Volume of drainage was strictly controlled after surgery. Remove the epidural drainage after primitive healing of the dura mater. The lumbar catheter was removed after 7 to 10 days. The indwelling time of each patient was collected and statistical analyzed. Results The observation group got obvious shorter epidural drainage indwelling time than the control group( P < 0. 05).Short-term postoperative complications did occur in some cases in observation group,however,there was no obvious increase of infection rate in patients with lumbar continuous drainage indwelling. Conclusion Lumbar cathetering during the operation could be an effective method to solve difficult problem of placeing a lumbar drainage after lumbar puncture and to prevent cerebrospinal fluid leakage after operations of lumbosacral vertebral canal. But it can not replace the delicate operation and tight dural suture. Drainage should be used only as a remedial measure of dural repair failure.更多还原