胸腰椎手术后脑脊液漏的防治

Prevention and treatment of cerebrospinal fluid leakage after thoracolumbar spine surgery

目的探讨胸、腰椎手术合并硬脊膜破裂的处理及并发脑脊液漏的治疗措施。方法回顾性分析64例硬脊膜破裂的处理及其9例脑脊液漏的治疗情况。结果行硬脊膜修补52例,并发脑脊液漏5例;未行硬脊膜修补12例,并发脑脊液漏1例;术中未见硬脊膜损伤而术后发生脑脊液漏3例;9例脑脊液漏患者无一例行切口探查硬脊膜修补术,均经合理卧位、漏口缝合、取头低脚高位、局部加压等治疗痊愈。结论硬脊膜破裂应积极修补;合理的卧位、头低脚高位对脑脊液漏的防治有十分重要的意义。

Objective To investigate the treatment of dural rupture or cerebrespinal fluid leakage complicated in thoracolumbar spine surgery, Methods The treatments of 64 patients with dural rupture, of whom 9 patients were complicated by cerebrospinal fluid leakage, were analyzed retrospectively. Results Dural repairs were performed in 52 patients, of which 5 patients were complicated by cerebrospinal fluid leakage; Dural repairs were not performed in 12 patients, of which 1 patients was complicated by cerebn）spinal fluid leakage;Dural lesion was not found during operations in 3 patients, who were complicated by cerebrospinal fluid leakage after operations. In none of the 9 patients with cerebrespinal fluid leakage, incision exploration and dural repairs were performed. All were cured by means of reasonable pone position, leak suture, trendelenburg position and local pressurization. Conclusion Dural ruptures should be repaired early ; reasonable pone position and trendelenburg positions are beneficial to the treatment and prevention of cerebrespinal fluid leakage.