延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察

Extended drainage time and intermittent clamping of the drainage tube for spinal cerebrospinal fluid leakage after spinal surgery

中文关键词:  脊柱手术  脑脊液漏  并发症  治疗

英文关键词:Spinal surgery  Cerebrospinal fluid leakage  Complications  Treatment

中文摘要:

  【摘要】 目的：评价延长切口引流时间并间断夹闭引流管治疗脊柱手术后脑脊液漏的效果。方法：1999年12月~2009年12月我科行脊柱手术1400例，术后出现脑脊液漏31例，其中男19例，女12例，年龄22~70岁，平均48.5岁。15例采用常规术后3d拔除切口引流管及更换切口敷料治疗（A组）,16例采用延长切口引流时间并间断夹闭引流管治疗（B组），两组在切口愈合前均应用抗生素预防感染。观察两组脑脊液漏消失和切口愈合时间及相关并发症情况。结果：A组脑脊液漏消失时间为20.0±3.8d，切口愈合时间为24.0±4.3d，其中8例初期治疗切口愈合，术后平均20d脑脊液漏消失；7例初期治疗失败，其中2例1周内脑脊液漏无减少趋势均行单纯硬膜修补，修补术后15d脑脊液漏消失；2例合并假性硬膜囊肿，行囊肿壁切除、硬膜修补常规术区放置引流管，术后15d复查MRI未见硬膜外脑脊液潴留；3例合并切口感染行切口切开彻底清创、对口置管冲洗引流及静脉应用抗生素，术后平均15d切口愈合。B组脑脊液漏的引流及消失时间为9.0±1.6d，切口均Ⅰ期愈合，愈合时间为14.0±2.5d，未出现假性硬膜囊肿及切口感染等并发症。B组脑脊液漏消失时间和切口愈合时间明显短于A组（P＜0.05）。结论：采用延长切口引流时间并间断夹闭引流管的方法治疗脊柱手术后脑脊液漏有效，效果优于常规术后3d拔除引流管并更换切口敷料的治疗方法。

英文摘要:

  【Abstract】 Objective：To evaluate the clinical outcome of extending drainage time and intermittent clamping of the drainage tube for spinal cerebrospinal fluid leakage after spinal surgery.Method：From December 1999 to December 2009，a total of 1400 patients underwent spinal surgery in our institute.Postoperative cerebrospinal fluid leakage occurred in 31 cases，who were 19 males and 12 females aged from 22 to 70 years old（average， 48.5 years old）.15 cases had wound drainage tubes removed after 3 days and routine wound dressings changed（group A）；while 16 cases experienced extended drainage time and intermittent clamping of the drainage tube（group B）.Antibiotics were used till the wound healed in both groups.The skin incision healing and CSF leaking-related complication were reviewed retrospectively.Result：The cerebrospinal fluid leakage in group A ceased at 20.0±3.8d，and the wound healed at 24.0±4.3d.8 cases had skin incision healed at the primary state of intervention and had CSF leakage ceased at 20d；7 cases did not respond in the primary state of intervention，among who，2 cases underwent dural repairing alone，which was effective until 15d.2 cases were complicated with pseudo-sac cyst，which was resolved by dissection of cyst wall and routine dural repair；3 cases presented with skin incision infection which was resolved by complete debridement and administration of antibiotics.The cerebrospinal fluid leakage in group B ceased at 9.0±1.6d.All skin incision got I stage heal at 14.0±2.5d.No pseudo-sac cyst and infection were noted，which showed significant difference between group A and B with regard to the CSF cease and skin incision healing time（P<0.05）.Conclusion:Extended drainage time and intermittent clamping of the drainage tube for spinal cerebrospinal fluid leakage after spinal surgery is more effective and reliable than conventional intervention.