胸腰椎后路手术并发隐性脑脊液漏治疗经验总结  

EXPERIENCE IN MANAGEMENT OF OCCULT CEREBROSPINAL FLUID LEAKAGE IN POSTERIOR THORACOLUMBAR SURGERY

作　　者：李晓龙[1] 徐练[1] 孔清泉[1] 杨进[1,2] 宋跃明[1] 李涛[1] 刘立岷[1] 龚全[1] 曾建成[1] 刘浩[1] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]泸州医学院附属医院骨科

出　　处：《中国修复重建外科杂志》2015年第5期572-575,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 总结胸腰椎后路手术并发隐性脑脊液漏的治疗经验,探讨切口部位引流管留置最佳时间,分析降低脑脊液切口漏出风险的方法。方法 回顾性分析2011年1月-2013年1月,胸、腰椎后路手术后发生隐性脑脊液漏的26例患者临床资料。男15例,女11例;年龄36～59岁,平均48.7岁。术后出现头痛19例;恶心5例,其中呕吐3例。23例引流管通畅、术后2 d内无脑脊液从皮肤切口漏出者,于第3天行夹闭引流管试验,其中21例无脑脊液切口漏出并拔管;2例出现脑脊液切口漏出,保守处理后第10天拔管。3例术后2 d内出现脑脊液切口漏出且保守处理无效者,再次手术清创、缝合切口,并留置引流管,术后第3天明确无脑脊液切口漏出后拔管。患者拔管后继续卧床3～5 d。结果 患者切口均愈合,愈合时间7～15 d,平均8 d。无1例出现切口感染、持续性脑脊液漏等并发症。拔管后患者头痛、恶心、呕吐等症状均立即缓解。患者均获随访,随访时间12～24个月,平均16个月。6个月时MRI检查示手术部位无1例出现皮下硬脊膜假性囊肿。结论 切口缝合质量是预防胸腰椎后路手术并发隐性脑脊液漏的关键因素。在保证缝合质量的前提下,可于术后第3天拔管。拔管前行夹闭引流管试验明确有无脑脊液切口漏出,以减少拔管后脑脊液从手术切口漏出的风险。Objective To summarize the experience in management of occult cerebrospinal fluid leakage （CSFL） in posterior thoracolumbar surgeries, and to explore the best drainage duration, as well as to analyse the ways to reduce the risk of CSFL. Methods A retrospective analysis was made on the clinical data of 26 patients with occult CSFL in posterior thoracolumbar surgeries between January 2011 and January 2013. There were 15 males and 11 females, with the average age of 48.7 years （range, 36-59 years）. Headache occurred in 19 cases, and 5 cases had nausea with 3 cases also having vomiting after operation. Drainage tube unobstructed and no CSFL from the skin incision were observed in 23 cases at the postoperative 2nd day, and the drainage pipe clamp test was performed at the 3rd day. Twenty-one patients had no CSFL and were given extubation; 2 cases having CSFL were given extubation after conservative treatments for 10 days. Three patients had CSFL with ineffective conservative treatments at the postoperative 2nd day, then received reoperation, incision suture, and drainage. At the postoperative 3rd day, if no CSFL was observed, these patients were given extubation and stayed in bed for 3-5 days. Results All incisions healed and the healing time was 7-15 days （mean, 8 days）. No incision infection, persistent CSFL, and other complications occurred. After extubation, headache, nausea, vomiting, and other symptoms were alleviated immediately. All patients were followed up 12-24 months （mean, 16 months）. MRI at the postoperative 6th month showed no subcutaneous epidural pseudocyst. Condusion The quality of suturing is the key factor to prevent occult CSFL in posterior thoracolumbar surgery. Under the premise of good suture quality, extubation can be given at the postoperative 3rd day. Before extubation, the drainage pipe clamp test can be performed to make sure no CSFL and to reduce the risk of CSFL from the surgical incision after extubation.

关 键 词：隐性脑脊液漏 胸腰椎后路手术 引流 

分 类 号：R687.3[医药卫生—骨科学]