腰大池置管引流治疗颈椎前路手术后并发脑脊液漏
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摘要
目的探讨腰大池置管引流治疗颈椎前路手术后并发脑脊液漏的临床疗效及安全性。方法回顾性分析2011年6月—2016年12月颈椎前路手术后并发脑脊液漏并接受腰大池置管引流治疗的17例患者(观察组)的临床资料,以同时期因外伤致硬膜破损脑脊液漏并接受腰椎穿刺引流术治疗的21例患者作为对照组,以治愈率、引流时间、24 h引流量、头痛持续时间以及治疗期间头晕、恶心、呕吐发生例数评价治疗脑脊液漏的疗效;以并发症发生和随访期恢复情况评价其安全性。结果所有患者均随访>12个月,2组患者脑脊液漏均治愈。观察组脑脊液24 h引流量明显高于对照组,头痛持续时间、引流时间均短于对照组,差异均有统计学意义(P <0.05);观察组治疗期间头晕、恶心、呕吐发生例数显著低于对照组,差异具有统计学意义(P <0.05)。所有病例均未发生颅内感染等严重并发症。观察组伤口愈合良好,随访期内无再发脑脊液漏、脑脊液囊肿形成;对照组治疗期内并发高热1例,经抗感染治疗后痊愈,随访期内1例患者脑脊液漏复发。结论腰大池置管引流治疗颈椎前路手术后并发脑脊液漏疗效确切,具有治疗时间短、并发症少、患者痛苦小的优点,值得临床推广应用。
Objective To investigate the clinical efficacy and safety of lumbar cistern drainage(LCD) for the treatment of cerebrospinal fluid(CSF) leakage after anterior cervical surgery. Methods From June 2011 to December 2016,the clinical data of 17 patients with CSF leakage after anterior cervical surgery treated by LCD were analyzed retrospectively(observation group). At the same time,21 patients with CSF leakage caused by traumatic dural injury were treated with lumbar puncture drainage as the control group. The cure rate,drainage time,24 h drainage volume,headache duration and the incidence of dizziness,nausea and vomiting in 2 groups during treatment period were used to evaluate the clinical efficacy;the safety was evaluated by complications and recovery during follow-up period. Results All 38 patients were followed up >12 months,and CSF leakage was cured in 2 groups. 24 h CSF drainage volume was higher in the observation group than in the control group and headache duration and drainage time were shorter in the observation group than in the control group,with statistically significant differences(P < 0.05). The incidence of dizziness,nausea.and vomiting in the observation group was significantly lower than that in the control group(P < 0.05). No serious complications such as intracranial infection occurred in all the cases. The wound healing was good in the observation group. No recurrent CSF leakage or CSF cyst formation was found during the follow-up period. In the control group,1 patient suffered from hyperthermia during the treatment period,and recovered after anti-infection treatment;CSF leakage recurred in 1 patient during the follow-up period. Conclusion LCD is effective in the treatment of CSF leakage after anterior cervical surgery. It has advantages of shorter treatment time,less complications and less pain in patients,and is worthy of wifer clinical application.
Objective To investigate the clinical efficacy and safety of lumbar cistern drainage(LCD) for the treatment of cerebrospinal fluid(CSF) leakage after anterior cervical surgery. Methods From June 2011 to December 2016,the clinical data of 17 patients with CSF leakage after anterior cervical surgery treated by LCD were analyzed retrospectively(observation group). At the same time,21 patients with CSF leakage caused by traumatic dural injury were treated with lumbar puncture drainage as the control group. The cure rate,drainage time,24 h drainage volume,headache duration and the incidence of dizziness,nausea and vomiting in 2 groups during treatment period were used to evaluate the clinical efficacy;the safety was evaluated by complications and recovery during follow-up period. Results All 38 patients were followed up >12 months,and CSF leakage was cured in 2 groups. 24 h CSF drainage volume was higher in the observation group than in the control group and headache duration and drainage time were shorter in the observation group than in the control group,with statistically significant differences(P < 0.05). The incidence of dizziness,nausea.and vomiting in the observation group was significantly lower than that in the control group(P < 0.05). No serious complications such as intracranial infection occurred in all the cases. The wound healing was good in the observation group. No recurrent CSF leakage or CSF cyst formation was found during the follow-up period. In the control group,1 patient suffered from hyperthermia during the treatment period,and recovered after anti-infection treatment;CSF leakage recurred in 1 patient during the follow-up period. Conclusion LCD is effective in the treatment of CSF leakage after anterior cervical surgery. It has advantages of shorter treatment time,less complications and less pain in patients,and is worthy of wifer clinical application.
引文
[1]Yoshihara H,Yoneoka D.Incidental dural tear in spine surgery:analysis of a nationwide database[J].Eur Spine J,2014,23(2):389-394.
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[3]Takahashi Y,Sato T,Hyodo H,et al.Incidental durotomy during lumbar spine surgery:risk factors and anatomic locations:clinical article[J].J Neurosurg Spine,2013,18(2):165-169.
[4]Chen Z,Shao P,Sun Q,et al.Risk factors for incidental durotomy during lumbar surgery:a retrospective study by multivariate analysis[J].Clin Neurol Neurosurg,2015,130:101-104.
[5]周纲,张玉坤,黄卫民,等.硬脊膜修补并腰大池置管持续引流:脊柱手术后脑脊液漏合并脑膜炎的治疗[J].中国组织工程研究,2015,19(34):5513-5517.
[6]于江龙,兰世英.腰大池置管持续引流治疗脑脊液漏的临床疗效[J].新疆医科大学学报,2012,35(9):1224-1227.
[7]石磊,陈德玉,史建刚,等.颈椎前路手术中硬膜损伤的预防与治疗[J].脊柱外科杂志,2017,15(3):156-160.
[8]孔金海,肖辉,孙正望,等.腰大池引流术在难治性脑脊液漏中的运用价值[J].脊柱外科杂志,2014,12(5):309-312.
[9]李波,陈喜安.腰大池置管持续引流治疗脊柱术后脑脊液漏的疗效分析[J].中国脊柱脊髓杂志,2011,21(6):456-458.
[10]于凤宾,陈德玉,王新伟,等.颈前路后纵韧带骨化切除术并发脑脊液漏的处理及疗效分析[J].中国脊柱脊髓杂志,2012,22(10):889-893.
[11]李伟.脊髓型颈椎病前路手术并发症的观察[J].现代诊断与治疗,2013,24(4):855-856.
[12]严朝俊.腰大池置管持续外引流治疗34例外伤性脑脊液漏疗效观察[J].中国卫生标准管理,2014,5(17):19-20.
[13]高利峰,侯秀伟,刘雅普,等.腰大池脑脊液外引流管理系统治疗颈前路术后脑脊液漏[J].医学新知杂志,2017,27(3):286-287.
[14]高亮亮,肖建如,严望军,等.腰大池引流治疗颈椎肿瘤术后脑脊液漏[J].脊柱外科杂志,2016,14(6):352-355.
[2]Yoshihara H,Yoneoka D.Incidental dural tear in lumbar spinal decompression and discectomy:analysis of a nationwide database[J].Arch Orthop Trauma Surg,2013,133(11):1501-1508.
[3]Takahashi Y,Sato T,Hyodo H,et al.Incidental durotomy during lumbar spine surgery:risk factors and anatomic locations:clinical article[J].J Neurosurg Spine,2013,18(2):165-169.
[4]Chen Z,Shao P,Sun Q,et al.Risk factors for incidental durotomy during lumbar surgery:a retrospective study by multivariate analysis[J].Clin Neurol Neurosurg,2015,130:101-104.
[5]周纲,张玉坤,黄卫民,等.硬脊膜修补并腰大池置管持续引流:脊柱手术后脑脊液漏合并脑膜炎的治疗[J].中国组织工程研究,2015,19(34):5513-5517.
[6]于江龙,兰世英.腰大池置管持续引流治疗脑脊液漏的临床疗效[J].新疆医科大学学报,2012,35(9):1224-1227.
[7]石磊,陈德玉,史建刚,等.颈椎前路手术中硬膜损伤的预防与治疗[J].脊柱外科杂志,2017,15(3):156-160.
[8]孔金海,肖辉,孙正望,等.腰大池引流术在难治性脑脊液漏中的运用价值[J].脊柱外科杂志,2014,12(5):309-312.
[9]李波,陈喜安.腰大池置管持续引流治疗脊柱术后脑脊液漏的疗效分析[J].中国脊柱脊髓杂志,2011,21(6):456-458.
[10]于凤宾,陈德玉,王新伟,等.颈前路后纵韧带骨化切除术并发脑脊液漏的处理及疗效分析[J].中国脊柱脊髓杂志,2012,22(10):889-893.
[11]李伟.脊髓型颈椎病前路手术并发症的观察[J].现代诊断与治疗,2013,24(4):855-856.
[12]严朝俊.腰大池置管持续外引流治疗34例外伤性脑脊液漏疗效观察[J].中国卫生标准管理,2014,5(17):19-20.
[13]高利峰,侯秀伟,刘雅普,等.腰大池脑脊液外引流管理系统治疗颈前路术后脑脊液漏[J].医学新知杂志,2017,27(3):286-287.
[14]高亮亮,肖建如,严望军,等.腰大池引流治疗颈椎肿瘤术后脑脊液漏[J].脊柱外科杂志,2016,14(6):352-355.
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