胸腰椎后路手术发生脑脊液漏的相关原因及处理

The reasons and managements of cerebrospinal fluid leakage secondary to posterior thoracic and lumbar spinal surgery

目的探讨胸腰椎后路术后发生脑脊液漏的相关原因及处理对策。方法选取2010-08—2014-08在我院行胸腰椎后路手术的患者320例,对其中发生脑脊液漏的患者进行处理。结果 320例患者中发生脑脊液漏14例,经术中、术后相应处理,均在术后3~12d内拔出引流管,术后2周内均拆除缝线,伤口恢复良好,无颅内感染。结论对于脑脊液漏重点在于预防,术中对硬脊膜的严密缝合等修补措施十分关键,术后体位的保持、伤口的清洁、引流结合合理使用抗生素等措施是防治脑脊液漏简单有效的方法。

Objective To investigate the reason and surgical management of postoperative cerebrospinal fluid leakage in spinal surgeries. Methods A retrospective research was designed and 320 patients with complete data who underwent posteriorthoracic and lumbar spinal surgery between August 2010 and August 2014 in our hospital were selected. Results Cerebrospinal fluid leakage occurred in 14 cases of 320 patients. Through the corresponding treatment in and after the operation, all the pa- tients recovered well. The drainage catheters were removed within 3-12 days. Two weeks after the operation, all patients＇ suture was removed and the superficial wound recovered well. And there was no central nervous system infection occurred. Conclusion We should focus on the prevention of cerebrospinal fluid leakage. It is critical to tightly suture the endorachis dur ing the operation. The maintenance of body position, keeping the incision clean, full drainage with proper use of antibiotics is safe and effective method for the prevention and treatment of cerehrospinal fluid leakage.