听神经瘤骨瓣成形术和骨窗术术后脑脊液切口漏的对比研究  

Comparative study of cerebrospinal fluid wound leak caused by craniotomy and craniectomy in the removal of acoustic neuroma

作　　者：吴小军[1] 胡国汉[1] 钱俊[1] 骆纯[1] 陈菊祥[1] 卢亦成[1] 

机构地区：[1]第二军医大学附属长征医院神经外科,上海200003

出　　处：《中国微侵袭神经外科杂志》2011年第5期203-205,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨骨瓣成形术能否减少乙状窦后入路听神经瘤术后脑脊液切口漏。方法回顾性分析172例听神经瘤病人的临床资料,采用骨瓣成形术41例(骨瓣成形组),骨窗术131例(骨窗组);对比两种手术方法脑脊液切口漏的发生率。结果骨瓣成形组:肿瘤全切除14例(34.1%),部分切除27例(65.9%);术后脑室外引流3例(7.3%),硬脑膜严密缝合23例(56.1%),脑脊液切口漏4例(9.8%)。骨窗组:肿瘤全切除47例(35.9%),部分切除84例(64.1%);术后行脑室外引流10例(7.6%),硬脑膜严密缝合109例(83.2%),脑脊液切口漏9例(6.9%),脑穿通畸形3例,皮瓣下积液1例。统计学分析表明:控制硬脑膜严密缝合因素后,两组脑脊液切口漏发生率无明显差异(Waldχ2=0.28,P=0.594)。结论采用骨瓣成形术和骨窗术后脑脊液切口漏发生率相当,是否采用骨瓣成形术与脑脊液切口漏发生率关系不大,但是骨瓣成形术后其他并发症较少,仍具有一定的临床应用价值。Objective To explore whether craniotomy could reduce the incidence of cerebrospinal fluid wound leakage in the removal of acoustic neuroma via retrosigmoid approach.Methods Clinical data of 172 patients with acoustic neuroma were analyzed retrospectively,including craniotomy in 41（craniotomy group） and craniectomy in 131（craniectomy group）.The incidence of cerebrospinal fluid wound leak after craniotomy or craniectomy was reviewed comparatively.Results In craniotomy group,total tumor removal was achieved in 14 patients（34.1%）,and partial removal in 27（65.9%）.External ventricular drainage was performed in 3 patients（7.3%） postoperatively,dural watertight suture achieved in 23（56.1%） and cerebrospinal fluid wound leakage occurred in 4（9.8%）.In craniectomy group,total tumors removal was achieved in 47 patients（35.9%）,and partial removal in 84（64.1%）.External ventricular drainage was performed in 10 patients（7.6%） postoperatively,dural watertight suture achieved in 109（83.2%）,cerebrospinal fluid wound leakage occurred in 9（6.9%）,porencephaly in 3,hydrops under skin flap in 1.There was no obvious difference in the incidence of cerebrospinal fluid wound leakage between the two groups（Wald χ2=0.28,P=0.594）.Conclusions There is no difference in the incidence of cerebrospinal fluid wound leakage between craniotomy and craniectomy.Nevertheless,craniotomy deserves clinical application for its fewer complications.

关 键 词：神经瘤 听 脑脊液切口漏 乙状窦后入路 骨瓣成形术 骨窗术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]