腰椎MED手术发生脑脊液漏的原因分析及对策

Analysis and Treatment of Cerebrospinal Fluid Leakage in Lumbar MED Operation

目的 分析显微椎间盘镜下髓核摘除手术 (Micro Endoscopic Discectom y,MED)并发硬脊膜损伤或脑脊液漏的原因特点 ,探讨其预防办法。方法 通过回顾性的方法对 1999年 12月至 2 0 0 3年 12月期间 4 5 2例 MED手术发生硬脊膜损伤或脑脊液漏的 15例患者临床资料进行分析总结。结果 术中发现硬脊膜损伤的 13例患者 ,有 9例术后出现脑脊液漏 ;2例术中未发现硬脊膜损伤的患者术后也出现了脑脊液漏 ;11例脑脊液漏患者经术后正规的保守治疗于 3～ 7d内治愈 ,无 1例脑脊髓膜炎 ,无继发的深部感染。结论 MED手术因其自身的特点 ,易发生硬脊膜损伤 ;但通过术前对病例仔细分析 ,术中具备一定的手术技巧 ,可以减少硬脊膜损伤的发生 ;术中对损伤硬脊膜及时堵塞或修补 ,术后采取正规的保守治疗措施 。

Objective To analyze the causes of dural injury or cerebrospinal fluid leakage in lumbar MED operation,and summarize the treatment and prevention.Methods A retrospective analysis was taken to the 15 cases suffered from dural injury or cerebrospinal fluid leakage among 452 cases after lumbar MED operation from December 1999 to December 2003.Results 13 cases occureed dural injury,9 cases appeared postoperative cerebrospinal fluidleakage.2 cases not discovered dural injury or cerebrospinal fluid leakage in operation appeared postoperative too.Through careful treatment postoperative,11 cases cured from three days to seven days by conservation measurement,no cerebrospinal meningitis occurred.Conclusion Lumbar MED operation is easy to occour dural injury or cerebrospinal fluid leakage.But through careful analysis the case preoperative and provided with surgically skill in operation,the amounts of dural injury can be decreased,almost all cerebrospinal fluid leakage can be cured by reparing dura mater or blocking up leakage in operation and regular conservative treatment after operation.