改良硬膜下补丁间断缝合修补法对预防幕上开颅术后并发症的作用研究

Study on the effect of modified subdural patch with intermittent suture on prevention of complications after supratentorial craniotomy

目的探讨幕上开颅手术术中硬膜缺损时所采用不同的硬膜修补方法,研究相关并发症的发生情况,评估其临床应用优势.方法回顾性研究自2018年5月至2019年5月在新疆医科大学第一附属医院神经外科由同一术者完成的135例幕上病变手术患者,在修补硬脑膜群缺损时,采用改良硬膜下补丁间断缝合法71例(实验组),同期采用自体骨膜或帽状腱膜连续缝合修补法64例(对照组),对比2组患者手术修补耗时、术后24h引流量,以及硬膜外积液、皮下积液及术后癫痫发作等并发症发生率,并对相关指标进行统计分析.结果实验组的平均硬膜修补耗时(12min)较对照组(25min)短,实验组的术后24h平均硬膜外引流量(278mL)高于对照组(245mL),实验组皮下积液发生率(1.41%)低于对照组(10.94%),实验组术后3个月内癫痫发作率(2.82%)低于对照组(14.06%),差异均具有统计学意义(P<0.05);实验组术后硬膜外积液发生率(5.63%)高于对照组(4.69%),但差异无统计学意义(P>0.05).7例患者硬膜外积液,无临床症状则无特殊处理,待其自行吸收;8例皮下积液患者均行腰大池引流治愈;10例患者于术后3个月出现癫痫发作,给予正规抗癫痫治疗后症状均控制,并在继续随访观察中.结论改良硬膜下补丁间断缝合修补法适用于各类开颅手术患者的硬脑膜修补手术,在缩短手术时间、预防术后皮下积液、癫痫发作等相关并发症中优势明显,值得临床推广.

Objective To investigate the incidence of related complications after different surgical types to repair dural defects during supratentorial craniocerebral operation, and to discuss which surgical types has the most advantages in clinical application. Methods A total of 135 cases(Supratentorial Craniotomy operated by the same surgeon) were enrolled retrospectively from May 2018 to May 2019. According to the performed surgical type, the 135 cases were divided into experimental and control group. The experimental group(71 cases) was repaired by modified interrupted suture with patch,the control group(64 cases) was repaired by continuous suture with autologous periosteum or galea aponeurotica. We compared the consuming time of repair, postoperative drainage volume 24 h after operation, and the incidence of complications such as postoperative epilepsy, epidural effusion and subcutaneous hydrops, and the statistical analysis was carried out to the related index. Results The average consuming time of experimental group was significantly shorter than that of control group(experimental group: 12 min;control group: 25 min), the average epidural drainage volume in the experimental group(278 mL) was higher than that in the control group(245 mL) at 24 h after operation.Among the experimental group, 1 case(1.41%) had subcutaneous hydrops, which was significantly lower than control group(10.94%). The incidence of postoperative epilepsy within 3 months in control group was significantly higher than experimental group(experimental group: 2.82%;control group: 14.06%), the difference is statistically significant(P <0.05). The incidence of postoperative epidural effusion in the experimental group(5.63%) was higher than that in the control group(4.69%), but no statistical significance was found(P >0.05). There was no special treatment to 7 epidural effusion cases without clinical symotoms, waiting for it to absorb on its own. All 8 cases of subcutaneous hydrops were cured by lumbar cistern drainage. Ten patients developed epileptic seizures 3 months after operation. Symptoms were controlled after regular antiepileptic treatment and were followed up.Conclusion Modified interrupted suture with patch can be used in kinds of dural defects during supratentorial craniocerebral operation, it has obvious advantages in shortening operation time, preventing related complications including subcutaneous hydrops and postoperative epilepsy, and is worthy of clinical promotion.