颈椎术后脑脊液漏治疗:不同引流方法比较

Comparison of various drainage methods for postoperative cerebrospinal fluid leakage in cervical vertebra

背景:大量的文献报道了脊柱术后脑脊液漏的各种治疗方法,包括术中及术后的处理措施,而仅针对颈椎术后脑脊液漏采用腰椎蛛网膜下腔置管引流的治疗方法报道甚少。目的:评价术区持续引流和腰椎蛛网膜下腔置管引流对颈椎术后脑脊液漏的治疗效果。方法:2009年6月至2012年10月新疆医科大学第一附属医院脊柱外科行颈椎手术923例,术后出现脑脊液漏24例,脑脊液发生率为2.6%(24/923),均为术中无法修补的硬膜裂伤及未发现的硬膜破裂而发生脑脊液漏。其中12例患者采用腰椎蛛网膜下腔置管治疗(置管组),12例患者术区持续引流治疗(引流组)。结果与结论:与引流组比较,置管组脑脊液漏停止时间明显缩短(P<0.05)。置管组出现1例脑脊液感染,引流组出现2例脑脊液囊肿,1例脑脊液感染,均给予对症治疗后治愈。24例均获得随访,随访时间9-12个月,均未出现脑脊液漏、脑脊液感染、脑脊液囊肿等并发症。结果可见腰椎蛛网膜下腔置管引流在治疗颈椎术后脑脊液漏方面有较好疗效。

BACKGROUND： Numerous studies have demonstrated various therapeutic methods for cerebrospinal fluid leakage after spinal column surgery, including intraoperative and postoperative measures. Few studies addressed the therapeutic methods of cerebrospinal fluid leakage after cervical vertebra surgery using lumbar subarachnoid catheter drainage. OBJECTIVE： To evaluate the therapeutic efficacy of sustainable drainage and lumbar subarachnoid catheter drainage for cervical postoperative cerebrospinal fluid leakage. METHODS： 923 patients underwent cervical spine surgery in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, China from June 2009 to October 2012. There were 24 cases of postoperative cerebrospinal fluid leakage with an incidence of cerebrospinal fluid leakage of 2.6%（24/923）. The dural laceration that could not be repaired or be found induced cerebrospinal fluid leakage. Of them, 12 cases received lumbar subarachnoid catheter drainage（catheter group）, and 12 cases received sustainable drainage（drainage group）. RESULTS AND CONCLUSION： Compared with the drainage group, the duration of cerebrospinal fluid leakage was significantly shorter in the catheter group（P 0.05）. In the catheter group, one case affected cerebrospinal fluid infection. In the drainage group, two cases experienced cerebrospinal fluid cyst and one case suffered from cerebrospinal fluid infection. They were cured by symptomatic treatment. A total of 24 cases were followed up for 9-12 months. None of them affected cerebrospinal fluid leakage, cerebrospinal fluid infection or cerebrospinal fluid cyst. Results demonstrated that lumbar subarachnoid catheter drainage in the treatment of cervical postoperative cerebrospinal fluid leakage has a good effect.