腰大池引流对脊柱哑铃型肿瘤手术后脑脊液漏及相关并发症的影响  

Application and effects of lumbar cerebrospinal fluid drainage for cerebrospinal fluid leakage patients after spinal dumbbell tumors operations

作　　者：吴志强[1] 严旭[1] 邵擎东[1] 许天明[1] 肖建如[2] 

机构地区：[1]解放军第455医院骨科,上海200052 [2]第二军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《中国骨与关节杂志》2016年第5期380-383,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨腰大池引流技术对脊柱哑铃型肿瘤术后脑脊液漏及相关并发症的影响,了解该技术的实用性。方法选取2012年2月至2014年10月,我科采用早期腰大池引流技术治疗的77例脊柱哑铃型肿瘤术后脑脊液漏患者作为治疗组,其中男42例,女35例,年龄16-74岁,平均48.6岁;选取2010年1月至2012年3月,引入腰大池引流技术前的71例同类患者作为对照组,其中男41例,女30例,年龄12-77岁,平均46.7岁。收集两组患者创口感染、创口不愈合、创区波动性隆起、迟发性创口开裂、持续性头痛、术后短暂性发热、顽固性发热的发生情况及腰大池引流前后创口引流量变化情况,并进行统计学处理。结果对照组77例中,术后创口感染6例,创口不愈合14例,创区术后出现波动性隆起13例,迟发创口开裂6例,持续性头痛不适37例,短暂性发热40例,顽固性发热9例;治疗组71例中,术后创口感染1例,创口不愈合2例,创区波动性隆起2例,迟发性创口开裂1例,持续性头痛4例,短暂性发热13例,顽固性发热1例。对照组拔管前引流量（238±65）ml,创口引流管拔管天数（14.2±2.3）天;治疗组腰大池置管术前创口引流量（296±80）ml,腰大池引流后第2天引流量（103±31）ml,拔管前引流量（48±15）ml,创口引流管拔除天数（8.9±1.8）天。治疗组创口相关并发症的发生率、拔管前创口引流量、拔管天数均小于对照组,差异有统计学意义（P〈0.05）。结论早期腰大池引流技术对于脊柱哑铃型肿瘤术后脑脊液漏治疗及相关并发症预防具有重要的临床价值,可以减少切口相关并发症、脑脊液漏相关发热、脑脊液皮下囊肿等不利情况发生。Objective To investigate the value of lumbar cerebrospinal fluid drainage technique by comparing the 2 groups＇ complications [ using lumbar cerebrospinal fluid （ CSF ） drainage postoperatively or not ], and to understand the practicability of this technique. Methods From February 2012 to October 2014, CSF drainage technique was used in the treatment of CSF leakage caused by dumbbell tumors resection and spinal stability reconstruction. Seventy-seven cases （ 42 males, 35 females, aged from 16 to 74 years, with an average age of 48.6 years ） using CSF drainage were classified as the treatment group. Seventy-one patients （ 41 males, 30 females, aged from 12 to 77 years, with an average age of 46.7 years ） receiving conventional treatment from January 2010 to March 2012 were classified as the control group. Incidence of wound infection, wound non-healing, wound area fluctuation, delayed wound dehiscence, persistent headache （ over 24 hours ）, postoperative transient fever （ within 1 week ）, refractory fever （ over 1 week ） and the volume change of the wound drainage after CSF drainage were collected in 2 groups. The data were analyzed statistically. Results In the control group, 6 cases were of postoperative wound infection, 14 cases of wound non-healing, 13 cases of postoperative wound area fluctuation, 6 cases of delayed wound dehiscence, 37 cases of persistent headaches, 40 cases of transient fever, and 9 cases of refractory fever. In the treatment group, the corresponding data were respectively 1 case, 2 cases, 2 cases, 1 case, 4 cases, 13 cases and 1 case. The wound drainage volume of the control group before wound drainage tube removal was （ 238 ± 65 ） ml, lasting for （ 14.2 ± 2.3 ） days; the wound drainage volume of the treatment group before the lumbar CSF fluid drainage was （ 296 ± 80 ） ml, and it was reduced to （ 103 ± 31 ） ml on the second day after lumbar CSF drainage. The wound drainage tube could be removed when the wound drainage volume was （ 48 q- 15 ）

关 键 词：脊柱 骨肿瘤 外科手术 引流术 硬膜下积液 

分 类 号：R738.1[医药卫生—肿瘤]