腰大池引流术在难治性脑脊液漏中的运用价值

Value of lumbar subarachnoid drainage in refractory cerebrospinal fluid leakage following removal of spinal tumors

目的探讨腰大池引流术在脊柱肿瘤硬膜囊缺损合并难治性脑脊液漏患者中的应用价值。方法回顾性分析本院2005年1月~2012年12月收治的84例脊柱肿瘤硬膜缺损合并难治性脑脊液漏的患者,行持续性腰大池引流术,观察患者术后即刻,术后1周,术后3周时体温变化;术前、术后1周,术后3周时白细胞、血沉,C-反应蛋白的变化。术后3 d、1周,3周内脑脊液量变化的情况。结果实施腰大池引流术后,患者体温、白细胞、血沉、C-反应蛋白出现先升高,随着治疗的进行而逐渐下降恢复为正常水平。放置腰大池引流前,患者脑脊液引流量为135~670 m L/d,平均356 m L/d;术后3周时,多数患者引流量已经降至正常。腰大池引流的放置时间13~25 d,平均16.3 d。腰大池引流中发生引流过度4例、引流不畅3例、引流管滑脱1例,经过调整引流速度,冲洗疏通管腔,适时缝闭皮缘达到满意效果。至末次随访时,原伤口中1例出现皮肤发红,1例发生局部血肿,1例伤口愈合不佳,1例伤口渗液,其余患者均取得了较良好的引流效果,并实现顺利拔除原伤口引流管。结论脊柱肿瘤中多数硬膜囊缺损无法完全缝合修补。对伴有难治性脑脊液漏患者采取降低局部脑脊液压力的持续性腰大池引流术,对促进硬膜的修复和预防并发症的发生有显著的效果。

Objective To evaluate the application of lumbar subaraehnoid drainage with dura reparation in spinal tumor with refractory eerebrospinal fluid leakage. Methods From January 2005 to December 2012, 84 cases with refractory cerebro- spinal fluid leakage were retrospectively analyzed. All patients received lumbar subarachnoid drainage. Temperature were observed at postoperative immediately, 1 week and 3 weeks after operation. And the leucocyte, blood sedimentation, and the change of C-reactive protein （CRP） were observed at preoperative, 1 week and 3 weeks after operation. The changes of cere- brospinal fluid were observed at 3 d, 1 week and 3 weeks after operation. Results The temperature, leucocyte, blood sedi- mentation and CRP were raised after the lumbar subarachnoid drainage, then dropped back to normal with treatment continu- ous. The eerebrospinal fluid volume was 135-670 mL/d （average 356 mL/d） before lumbar subarachnoid drainage, and most of patients＇ dropped to normal in 3 weeks after the operation. The average drainage time was 16.3 d. Until to final follow-up, 4 cases had excessive drainage, 3 cases had poor drainage and 1 case had drainage tube slippage. One case occurred skin red- ness, 1 case had poor wound healing, 1 case had wound effusion, and the remaining patients were achieved good drainage effect and the original wound drainage tubes were removed. Conclusion Dura reparation is a good choice for spinal tumor with dura defect which can not be sutured. For patients with a huge amount of cerebrospinal fluid drainage, lumbar subarach- noid drainage is a reliable and effective treatment, and it＇ s good to promote epidural reparation and prevent complications occurrence.