颈椎前路手术早期并发症分析及其对策

Early complications of anterior cervical spine surgery and countermeasures

目的分析颈椎前路手术早期并发症的发生原因及处理方法。方法 64例中23例(29例次)出现早期并发症(9种),发生率为35.94%。对各种并发症的发生原因进行分析,介绍了对症处理的方法。结果并发症为:肺部感染8例;喉返神经损伤2例;颈部切口感染1例;食管瘘1例;术后低血压4例;低钠血症6例;脑脊液漏2例;椎动脉损伤1例;尿路感染4例。其中3例患者同时并发肺部感染和低钠血症及尿路感染。除2例肺部感染患者死亡外,其余发生并发症患者均康复。结论颈椎创伤后前路手术早期并发症较多,主要与伤情严重程度及术者操作水平、围手术期处理相关,严格围手术期处理,提高手术操作技巧,及时正确处理并发症,能减少并发症的发生及提高并发症治愈率。

Objective To evaluate the early complications of anterior cervical spine surgery and countermeasures.Methods 64 patients were treated with anterior cervical spine surgery.The early complications and countermeasures were reviewed.23 cases（29 complications）got intraoperative and early postoperative complications（35.94%）.By analyzing causes of complications,the countermeasures were developed.Results The major complications were as follows：lung infection in 8 cases;injury of laryngeal recurrent nerve in 2;neck incision infection in 1;esophageal fistula in 1;postoperative hypotension in 4;hyponatremia in 6;cerebrospinal fluid leakage in 2;vertebra artery injury in 1;and urinary tract infection in 4.There were three patients who got pulmonary infection and hyponatremia and urinary tract infections at the same time.Two patients with pulmonary infection died and the rest were recovered.Conclusions The post-traumatic anterior cervical spine surgery are likely to get early complications,mainly related to injury severity,surgeon＇s operation skill,and preoperative preparation.Adequate preoperative preparation and improving operative techniques,timely and correctly handle the complications that could reduce complications and improve cure rate of complications.