人工硬脑膜在乙状窦后入路手术中的应用技巧和疗效分析  

The skill s and efficacy of applicating artificial dura in retrosigmoid approach

作　　者：李新宇[1] 王晓松[2] 陈国强[2] 王宁[2] 孙恺[1] 杨廷舰[3] 

机构地区：[1]潍坊医学院,潍坊261053 [2]中国医科大学航空总医院神经外科,北京100012 [3]潍坊医学院附属医院神经外科,潍坊261000

出　　处：《中华神经创伤外科电子杂志》2016年第1期19-22,共4页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

摘　　要：目的探讨人工硬脑膜对于预防乙状窦后入路手术的脑脊液漏和减少术后不良反应的最佳使用方法。方法回顾性分析中国医科大学航空总医院神经外科自2015年3月至2015年6月收治的231例经乙状窦后入路开颅手术的患者资料,根据人工硬膜放置位置不同分成两组(硬膜下组为A组,硬膜外组为B组),对比分析两组术后体温变化及相关并发症的发生率。结果两组患者术后体温变化有显著差异(P<0.01),A组患者术后因发热所需的临床干预率为6.1%,出现脑脊液漏的概率为0%,出现颅内感染的概率为1%,出现皮下积液的概率为1%;B组患者术后因发热所需的临床干预率为25.6%,出现脑脊液漏的概率为3%,出现颅内感染的概率为3.8%,出现皮下积液的概率为7.5%。结论在乙状窦后入路手术中将人工硬脑膜贴敷并固定在硬膜下使术后发热率大幅度降低,并能有效降低脑脊液漏等并发症的发生率。Objective To explore an optimal approach for the usage of artificial dura mater applied to the prevention of postoperative cerebrospinal fluid leakage as well as the reduction of postoperative complications in retrosigmoid sinus approach. Methods To perform retrospective analysis on the data of 231 patients with retrosigmoid sinus approach surgery, and patients were divided into 2 groups （group A and group B） according to the placement of the artificial dura. Group A： artificial dura mater was put in subdural; group B： artificial dura mater was placed in epidural. Temperature changes and associated incidence of complications in different time after surgery were comparatively analyzed in both groups. Results Significant differences of changes in body temperature could be spotted between both groups （P〈0.01）, patients in group A fever desired clinical intervention was 6.1%, the probability of the emergence of cerebrospinal fluid leakage was 0%, the probability of the emergence of intracranial infection 1%, probability of 1% seroma; The fever patients in group B required clinical intervention was 25.6%, the probability of the emergence of cerebrospinal fluid leakage was 3%, the probability of intracranial infection was 3.8%, subcutaneous 7.5% probability of effusion. Conclusion When taking retrosigmoid sinus approach surgery, the artificial dura mater fixed below and patched well could significantly reduce the rate of postoperative fever, and effectively reduce the incidence of complications.

关 键 词：人工硬膜 乙状窦后入路 术后发热 并发症 

分 类 号：R651.1[医药卫生—外科学]