腰大池置管外引流在脑肿瘤术后的应用体会  

Application of postoperative external drainage of lumbar cistern for patients with brain tumor

作　　者：张继[1] 朱正权 孙叔昕 何振强 符土平 林富华[1] 陈银生[1] 蒋小兵[1] 赛克[1] 牟永告[1] ZHANG Ji;ZHU Zheng-quan;SUN Shu-xin;HE Zhen-qiang;FU Tu-ping;LIN Fu-hua;CHEN Yin-sheng;JIANG Xiao-bin;SAI Ke;MOU Yong-gao(Department of Neurosurgery,Cancer Center of Sun Yat-sen University,State Key Laboratory of Oncology in South China,Collaborative Innovation Center of Oncology,Guangzhou 510060,Guangdong,China)

机构地区：[1]中山大学肿瘤防治中心神经外科华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广东广州510060 [2]新疆维吾尔自治区肿瘤医院神经外科,新疆乌鲁木齐830011

出　　处：《广东医学》2018年第14期2131-2133,共3页Guangdong Medical Journal

基　　金：广州市科技计划项目(编号:201704020133)

摘　　要：目的探讨神经肿瘤术后患者腰大池置管持续外引流的临床意义,并对置管要领及治疗作用进行浅析。方法用配套的穿刺针在L_(3-4)或L_(4-5)椎间隙穿刺入蛛网膜下腔,引流管经针鞘导入腰大池3～10cm(成人5～10 cm,儿童3～5 cm)。观察脑脊液流出情况,衔接引流系统,设定引流管高度;脑脊液引流量控制在150～350 mL/d,留管时间3～28 d。结果 31例脑肿瘤术后出现发热、脑脊液白细胞数明显增高等颅内感染征象的患者中,14例腰大池置管留置皮下隧道的患者,1例出现脑脊液引流管口漏;17例未留置皮下隧道患者中,3例发生引流管管口脑脊液漏,腰大池置管持续引流有无留置皮下隧道引流管口脑脊液漏比较,差异有统计学意义(P<0.05)。3例脑脊液漏培养阳性患者,经有效抗生素治疗及持续引流脑脊液后拔管。31例留管时间3～28 d,平均(7.3±0.5)d,住院时间11～46 d,平均(14.6±2.1)d,且并发症少。结论腰大池置管外引流置管创伤小、成功率高,留置皮下隧道可降低脑脊液漏的发生率,是一种行之有效的治疗方法,值得临床参考应用。Objective To investigate the post-operative application of external drainage of cerebrospinal fluid in the lumbar cistern for brain tumor patients with fever and hematocele,and to report manipulation skill,therapeutic effect in details. Methods The puncturing spot was located at the L（3-4） or L（4-5） intervertebral level with the needle from the special drainage device. The drainage tube was inserted into the lumbar subarachnoid space（ 3-5 cm in children,5-10 cm in adult）. The soft drainage tube was linked to the drainage attachments. Set the height of the tube after confirming the cerebrospinal fluid flow. The amount of cerebrospinal fluid drainage was set between 150 and 350 mL per day. The retention time for the tube varied from 3 to 28 days. Results Thirty patients with brain tumors presented with intracranial infection sign such as fever and increased white blood cell in cerebrospinal fluid after surgery were included. In 14 patients with subcutaneous tunnel,1 patient developed cerebrospinal fluid drainage leakage. In 17 patients without subcutaneous tunnel,3 patients had cerebrospinal fluid leakage. There were significant differences in cerebrospinal fluid leakage aspect with or without subcutaneous tunnel（ P 〈 0. 05）. After effective antibiotic treatment and continuous drainage of cerebrospinal fluid,3 infected patients recovered. In 31 cases,the duration of tube retention was 3-28 days,with an average of（ 7. 3 ± 0. 5） days,and the average duration of hospitalization was 11-46 days [（ 14. 6 ± 2. 1） d]. The effect of the continuous drainage through the lumbar cistern was remarkable to these patients with postoperative fever and hematocele in surgical region. The relative complications were mild and rare. Conclusion The subcutaneous tunnel can reduce the risk of cerebrospinal fluid leakage and local infection. It is a safe and effective method with a wide range of application.

关 键 词：腰大池 置管外引流 脑肿瘤 发热 皮下隧道 

分 类 号：R739.41[医药卫生—肿瘤]