术中硬膜下置管防治椎管术后并发症的临床疗效观察

Subarachnoid catheter placement for continuous cerebrospinal fluid drainage during the intravertebral operations in prevention of postoperative complication

目的观察术中放置硬膜下引流管防治椎管硬膜下病变手术后切口并发症的临床疗效。方法回顾分析解放军总医院神经外科2015年1月-2016年6月共104例行椎管内硬膜下病变切除手术病例的临床资料,根据术中是否放置硬膜下引流管分为观察组(48例)和对照组(56例),两组病例性别、年龄、病程度差异无统计学意义。对比两组术后发热例数、脑脊液漏例数、硬膜外引流管留置时间、伤口愈合情况、术后住院天数。结果观察组和对照组发热分别5例和8例,切口愈合不良分别为3例和6例,术后并发症总例数分别为11例和21例,差异无统计学意义;术后脑脊液漏分别为3例和8例,硬膜外引流时间分别为(3.5±2.5)d和(5.8±3.4)d,术后住院时间分别为(5.3±2.4)d和(8.2±3.6)d,差异有统计学意义(P<0.05)。观察组均顺利置管,未造成永久性损害。结论术中硬膜下置管安全可行,可有效减少椎管硬膜下病变手术后脑脊液漏的发生,促进切口愈合。

Objective To study the clinical efficacy of subarachnoid continuous drainage placed in the intravertebral operations for prevention of postoperative complication. Methods The clinical data of 104 patients who underwent subarachnoid lesion resection in Neurosurgery Department of Chinese PLA General Hospital from January 2015 to June 2016 were retrospectively analyzed. These patients were divided into observation group （48 cases） and control group （56 cases） according to whether subarachnoid continuous drainage was placed during the operation or not. Complications including fever and cerebrospinal fluid leakage, the indwelling time, healing condition of surgical incisions and the postoperative hospital stay were collected and analyzed. Results Five cases in observation group got fever as compared with 8 cases in control group （P 〉 0.05）. There were no significant difference in occurrence of poor wound healing （3 in observation group vs 6 cases in control group）, cerebrospinal fluid leak （3 in observation group vs 8 cases in control group）, and total complications （11 in observation group vs 21 cases in control group）（P 〉 0.05, respectively）. The drainage duration of （3.5±2.5） days vs （5.8±3.4） days, the postoperative hospital stay of （5.3±2.4） days vs （8.2±3.6） days between the two groups showed statistically significant differences, respectively （P 〈 0.05）. The drainage catheters were successfully placed in all the patients of observation group. Despite of existed short-term complications, no permanent neural function damage was found. Conclusion Subarachnoid continuous drainage placement in the operation is safe and feasible. It can be an effective method to prevent cerebrospinal fluid leakage after operation of subarachnoid lesion resection and promote healing of the surgical incisions.