严重高位硬脊膜漏（附5例报告）  

SevereHighLevelLeakageofCerebroSpinalFluid

作　　者：张长明[1,2] 耿介[1,2] 耿叔平 朱小白 

机构地区：[1]浙江省人民医院骨科 [2]西安医科大学附一院

出　　处：《中华骨科杂志》1996年第2期94-96,共3页Chinese Journal of Orthopaedics

摘　　要：高位硬脊膜漏是颈后路手术并发症，一般可以自愈。而严重高位硬脊膜漏危害严重，治疗困难。作者通过对５例严重高位硬脊膜漏的治疗，认为术后３～４天伤口处每日引流脑脊液超过２００ｍｌ，且有增多趋势者，巳存在严重高位硬脊膜漏的可能，可采用头高足低位经腰椎蛛网膜下腔持续引流治疗。５例中有１例当行蛛网膜下腔引流时，引流液培养为大肠杆菌感染，其余４例漏口均在４～８天愈合，引流量每天１５０～５００ｍｌ，平均３５０ｍｌ。２例在引流过程中伴有头昏、恶心，补液后症状消失。随访３年２个月～４年６个月，无遗留症状。故认为该治疗方法有利于漏口闭合，且操作简单易行，无危险，是值得推荐的非手术治疗措施。LeakageofCSFathighlevel,acomplicationcausedbycervicaloperation,usualyre-coversspontaneously.However,severeleakageisverydangerousandhardtotreat.Basedontheob-servationsofthetreatmentof5casesofsevereleakageofCSF,theauthorspointoutthatsevereleak-ageofCSFshouldbeconsideredifthevolumeofdailydrainageexceeds200mlwithatendencytoin-creasein3-4daysafteroperation,andthatcontinuousdrainagethroughsubarachnoidcavityinhead-raisedpositionshouldbeadopted.Asthedrainageofsubarachnoidcavitybeinggiven,CSFcultureshowsoneofthe5caseshasbeeninfectedbyE.Coli.Theleakageinotherfourcaseshealedupin4～8days;thevolumeofdrainagerangedfrom150mlto500ml,withaaverageis350ml.2casessuffersfromdazzinessandmausia,whichdisappearedafterivfluidadministration.Therewasnosequelaefoundin38～54monthfolowing-up.Theauthorsbelievethatsimpleandsafedrainageishelpfulforthehealingofleakage,canberecommendedasthemethodnon-operationtherapy.

关 键 词：硬脊膜漏 高位 引流 颈后路手术 并发症 

分 类 号：R653.05[医药卫生—外科学] R651.2[医药卫生—临床医学]