文档介绍：脊柱手术并发脑脊液漏的预防与处理
中文摘要
目的:分析脊柱手术并发脑脊液漏的原因,并探讨预防脑脊液漏的措施,及出现脑脊液漏后
的处理方法。
方法: 回顾性分析2010年1月1日~2014年1月1日福建医科大学附属漳州市医院脊柱术后出现
脑脊液漏的35例患者资料。拔管后引流管口深缝合为缝合组共15例,拔管后无深缝合为对照
组共20例。术中出现硬脊膜破损或发现脑脊液漏者,找出破损部位,破损面积<1/4周径,予
直接缝合;直径>1/4周径者予硬脊膜替代材料修补;无法缝合及修补者予明胶海绵填塞。逐
层严密缝合切口组织,常规放置负压引流管。术后缝合组在拔管后行引流管口深缝合并敷料
覆盖,对照组无引流管口深缝合直接敷料覆盖。两组均予卧床休息、调整体位等处理。回顾
性分析术中及术后处理效果。
结果:本研究35例脑脊液漏患者中,缝合组于术后6(4,18)天停止漏液,
±;对照组于术后11(5,41)天停止漏液,±。两
组对比有统计学差异(P<)。即术后有深缝合者脑脊液漏的治疗时间短于无缝合组。35例
中有8例并发手术切口感染,经敏感药物抗感染等处理后,感染控制效果佳,切口愈合良好。
结论:术后出现脑脊液漏者,在拔管后行引流管口处深缝合效果好,不但可减少脑脊液漏停
止时间,还能减少出现感染等并发症的概率。脊柱手术合并脑脊液漏经合理的保守治疗大都
能治愈。
关键词:脑脊液漏,脊柱手术,预防,处理
3
万方数据
P revention and Treatment of Ce re bro spina l F luid Leakage in Spinal
Surge ry
Abstract
Objective: To analyze the reasons of cerebrospinal fluid leakage (CSFL) in spinal
surgery, and to investigate the prevention and the treatment measures of
cerebrospinal fluid leakage.
Methods: A retrospective analysis was taken of 35 cases suffered cerebrospinal fluid
leakage after spinal surgery from January, 2010 to January, 2014 in our department.
The suture group in which the nozzle was deeply sutured after extubation consisted
of 15 cases, while the control group in which the nozzle was not deeply sutured after
extubation consisted of 20 cases. When dural damage or cerebrospinal fluid leakage
was encountered in the surgery, we found out the damaged parts and sutured it directly
if the damaged parts’diameter was less than 1/4 circumference, while repaired the
other with alternative materials when the diameter was greater than 1/4 circumference
pressed it with absorbable gelatin sponges directly when the damaged part was
hard to suture or to restore. Then negative pressure drainage tube was placed normally,
and incision tissue was sutured layer by layer at last. The nozzle was deeply sutured
in the suture group after extubation while not in the control group. Patients were
asked to bed rest, adjustin