小儿脊髓栓系综合征手术并发症的分析及处理

Analysis and Management of Operative Complications in Children with Tethered Cord Syndrome

目的了解脊髓栓系综合征(TCS)手术治疗的常见并发症,探讨其发生机制和处理措施,以指导手术。方法对2006年2月-2007年10月郑州大学第三附属医院收治的313例TCS患儿在显微操作下行脊髓探查松解术。对脊髓外翻、脊膜膨出破损患儿入院即予抗生素治疗。按年龄分为A组(1 d～3个月)82例、B组(>3个月～3岁)104例、C组(>3～7岁)60例、D组(>7～14岁)67例;按病理类型分为E组(椎管内脂肪瘤)77例、F组(椎管内囊肿)39例、G组(单纯脊髓栓系)113例、H组(脊膜膨出修补术后)84例。术后随访8～30个月,总结分析各组手术并发症发生情况,采用SPSS 10.0软件进行统计学处理。结果TCS手术并发症主要有下肢疼痛/腹胀(62例,19.8%)、排尿异常(65例,20.8%)、颅压升高(26例,8.3%)、脑脊液漏(18例,5.8%)、神经损伤(12例,3.8%)、术后黏连(13例,4.2%)等。另有2例(0.64%)因脑膜炎死亡,5例(1.6%)出现浅表褥疮。排尿异常、颅压升高、神经损伤、术后黏连在不同年龄组中的发生率均有显著差异(Pa<0.05);不同病理类型组中,G组神经损伤和术后黏连发生率相对较低。结论早期诊断和术中显微操作是治疗TCS的关键;新生儿和单纯脊髓栓系患儿术后并发症少;脊髓外翻、脊髓脊膜膨出破损患儿术前应用抗生素、营养支持能降低脑膜炎的发生。

Objective To find out the common complications induced by operation in children with tethered cord syndrome （TCS） and discuss the mechanism and treatment of these complications to guide operation. Methods A total of 313 cases of children, with TCS received spondylolysis under microsurgery at the Department of Pediatric Surgery in the Third Affiliated Hospital of Zhengzhou University from Feb. 2006 to Oct. 2007. The children with exposed spinal cord and damaged myelomeningocele were provided with antibiotics immediately when they were in hospital. All cases were classified into 4 groups according to age：group A（1 d -3 months old,82 cases） ,group B（3 months - 3 years old,104 cases）,group C（3 -7 years old,60 cases）,and group D（7 -14 years old,67 cases）. According to pathological types,they were also classified into 4 groups：group E （intraspinal lipoma ,77 cases）, group F （intarsia cyst ,39 cases）, group G （simple tethered cord, 113 cases ）, and group H （secondary operations for myelomeningocele ,84 cases）. Children were followed up for 8 -30 months. The operative complications were analyzed retrospectively and the results of prevention and treatment of these complications were analyzed statistically by SPSS 10.0 software. Results The operative complications in children with TCS included lower limb pain or abdominal distension（ 12 cases, 19.3 % ） , abnormal urination （ 65 cases, 20.8% ） , increased intracranial pressure （ 26 cases, 8.3% ）, cerebrospinal fluid leakage （ 18 cases, 5.8% ） ,nerve injury（ 12 cases,3.8% ） ,retethering（ 13 cases,4.2% ） ,and so on. Additionally,2 cases（0.64% ） died of meningitis,5 cases （ 1.6% ）appeared with superficial bedsore. In different age groups, the respective incidence of abnormal urination, increased intracranial pressure, nerve injury and retcthering were obviously different by statistical analysis （ Pa 〈 0. 05 ）. In different pathological type groups, nerve injury and retethefing incidence of group G were relatively lower than others. Conclusions Early diagnosis and microsurgical operation are the key to the treatment of TCS. Simple tethered cord and neonate have less post - operative complications. The preoperative application of antibiotics and nutritional support can reduce the incidence of meningitis in children with eversion of spinal cord and damaged myelomeningocele.