带蒂颅骨膜瓣在慢性脑脊液漏治疗中的应用  

Application of the pedicled pericranial flap in the treatment of chronic cerebrospinal fluid leakage

作　　者：向婷婷 吴为民[1] 温立霞[1] 刘亚鹏[1] 胡卫刚 夏明 Xiang Tingting;Wu Weimin;Wen Lixia;Liu Yapeng;Hu Weigang;Xia Ming(Department of Burn and Plastic Surgery,People’s Hospital of Three Gorges University(The First People’s Hospital of Yichang),Yichang 443000,China)

机构地区：[1]三峡大学人民医院(宜昌市第一人民医院)烧伤整形外科,宜昌443000

出　　处：《中华整形外科杂志》2022年第7期787-791,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨带蒂颅骨膜瓣在治疗慢性脑脊液漏中的应用效果。方法回顾性分析2016年4月至2020年10月,宜昌市第一人民医院收治的颅脑术后脑脊液漏患者的临床资料。手术彻底清除坏死组织,采用带蒂颅骨膜瓣修复硬脑膜缺损,以局部皮瓣修复软组织缺损,并以负压封闭引流敷料覆盖皮瓣切口创面,负压维持在-50~-80 mmHg(1 mmHg=0.133 kPa)。术后随访观察脑脊液漏、缺损修复及相关并发症发生情况。结果共纳入5例患者,男3例,女2例,年龄49~65岁,所有患者均为颅脑术后复合组织缺损,伴局部感染,病程2个月至12年。清创后硬脑膜缺损面积1.5 cm×2.0 cm~2.5 cm×3.0 cm,头皮软组织缺损面积2.0 cm×2.0 cm~3.0 cm×6.0 cm。带蒂骨膜瓣切取面积2.0 cm×3.0 cm~3.0 cm×3.5 cm,局部皮瓣切取面积为8.0 cm×13.0 cm~12.0 cm×16.0 cm。1例患者术后5 d仍有脑脊液漏,予以持续腰大池椎管穿刺脑脊液引流,1周后愈合;1例患者皮瓣缝合口局部愈合不良,经门诊换药2周后痊愈。术后随访3~17个月,均未再出现脑脊液漏,未发生颅内感染、额纹消失、头皮麻木及坏死等其他并发症。结论通过带蒂颅骨膜瓣修复硬脑膜缺损可较好地治疗慢性脑脊液漏,且供区损伤小、并发症少。Objective To investigate the effect of the pedicled pericranial flap in the treatment of chronic cerebrospinal fluid leakage.Methods A retrospective analysis was conducted based on the clinical data of patients with cerebrospinal fluid leakage after craniocerebral surgery who were admitted to the First People’s Hospital of Yichang from April 2016 to October 2020.The necrotic tissues were thoroughly removed.The dural defects were repaired with pedicled pericranial flaps,and soft tissue defects were repaired with local flaps.The incision was covered with negative pressure closed drainage dressing,and negative pressure was maintained at-50 to-80 mmHg(1 mmHg=0.133 kPa).Cerebrospinal fluid leakage,defect repair,and related complications were observed in postoperative follow-up.Results A total of five patients(three males and two females,aged 49-65 years)were included.All patients had postoperative composite tissue defects with local infection after craniocerebral surgery,lasting two months to 12 years.The size of the postoperative dural defect ranged from 1.5 cm×2.0 cm to 2.5 cm×3.0 cm.The size of the scalp soft tissue defect ranged from 2.0 cm×2.0 cm to 3.0 cm×6.0 cm.The size of the pericranial flap ranged from 2.0 cm×3.0 cm to 3.0 cm×3.5 cm,and the local flap ranged from 8.0 cm×13.0 cm to 12.0 cm×16.0 cm.The cerebrospinal fluid leakage was still observed in one patient at 5 d after the surgery and was treated with continuous lumbar pool puncture for cerebrospinal fluid drainage,which healed one week later.One patient suffered from poor healing of the flap incision,which healed after two weeks of outpatient dressing changing.At the postoperative follow-up of 3 to 17 months,none had any further cerebrospinal fluid leakage,and no other complications such as intracranial infection,loss of frontal lines,scalp numbness,and necrosis occurred.Conclusions Repair of dural defects by pedicled pericranial flaps can treat chronic cerebrospinal fluid leakage with less damage to the donor site and fewer complications.

关 键 词：脑脊液泄漏 带蒂颅骨膜瓣 硬脑膜缺损 修复外科手术 

分 类 号：R651.11[医药卫生—外科学]