负压封闭引流在治疗胸腰椎病变术后脑脊液漏中的应用

Application of vacuum sealing drainage( VSD) in the treatment of postoperative cerebrospinal fluid leakage( CSFL ) of thoracolumbar vertebral body disease

目的：观察负压封闭引流（vacuum sealing drainage,VSD）治疗胸腰椎病变术后脑脊液漏的临床疗效。方法：我科2010年2月至2014年2月23例采用VSD治疗胸腰椎病变术后脑脊液漏患者,均常规治疗,彻底清除切口内炎性水肿和坏死组织,生理盐水和稀释碘伏纱布条反复清洗切口,干纱布条将切口擦拭干净,于切口表面或切口内置VSD,术后俯卧位48-72 h。结果：所有病例切口完全愈合,未出现再次手术修补病例。其中17例置VSD 5-7 d后,换药7-10 d拆线出院;6例第一次VSD术后5-7 d,切口仍有少量渗液,再次置VSD 5-7 d后,换药4-5 d拆线出院。随访6个月-2年,所有病例无头晕、头痛、恶心及胸腰背部疼痛等症状,有2例发现较小的脑脊液囊肿,因无腰痛及神经症状而未处理。结论：VSD是治疗胸腰椎病变术后脑脊液漏有效而无创的方法。

Objective：To observe the clinical efficacy of vacuum sealing drainage（ VSD） in the treatment of postoperative cere-brospinal fluid leakage（CSFL） of thoracolumbar vertebral body disease. Methods： From February 2010 to February 2014,23 cases with postoperative CSFL of thoracolumbar vertebral body disease were treatted by VSD in our department. All cases received convention-al treatment,thorough cleaning out wound inflammatory edema and necrotic tissue,repeated washing incision by physiological saline and diluted iodophor gauze strip,wiping clean wound with dry gauze strip,placing VSD on cut surface or partly in incision and prone posi-tion 48-72 hours after operation. Results：All patients acquired wound healing completely,and there were no cases of surgical repair again. After 5-7 days of placing VSD,17 patients were discharged through changing dressings for 7-10 days again. After 5-7 days of placing VSD for the first time,6 patients had still a little incision oozing,after 5-7 days of putting VSD again,and the 6 cases were dis-charged by additional changing dressings for 4-5 days. Following up from 6 months to 2 years,in all cases there were no dizziness, headache,nausea,thoracic and lumbar back pain and other symptoms. 2 cases after lumbar spine surgery had small cerebrospinal fluid cysts,because there were no pain and neurological symptoms without treatment. Conclusion：VSD is an effective and atraumatic meth-od to remedy CSFL of the thoracic and lumbar lesions after operation.