脊柱外科术后脑脊液漏并颅内感染的诊治分析

Treatment of cerebrospinal fluid leakage associated with intracranial infection after spinal surgery

目的探讨脊柱外科术后脑脊液漏并颅内感染的治疗方案及临床疗效。方法回顾性分析2014年1月至2020年1月收治的11例脊柱外科手术后发生脑脊液漏并颅内感染的临床资料。5例单纯抗感染治疗,1例保持引流并抗感染治疗,5例抗感染联合腰大池引流治疗。结果 11例感染均有效控制;术后至出现发热时间5~11 d,平均(7.46±1.75)d;抗感染周期14~23 d,平均(19.55±2.73)d;脑脊液白细胞水平恢复正常时间10~19 d,平均(15.27±3.58)d;脑脊液糖定量恢复正常时间8~16 d,平均(12.91±2.74)d。结论脊柱外科术后脑脊液漏并颅内感染,应根据脑脊液漏情况选择不同方案,早期发现并控制感染是治疗成功的关键。持续腰大池引流联合抗感染有助于渗漏严重病人的治疗。

Objective To investige the management and outcome of cerebrospinal fluid leakage(CSFL) associated with intracranial infection after the spinal surgery.Methods A retrospective analysis was performed on the clinical data of 11 patients with CSFL associated with intracranial infection after the spinal surgery.According to the severity of CSFL,5 patients were treated with simple anti-infection,1 was keeping the subcutaneous drainage tube and treated with anti-infection,5 were treated with anti-infection combined with lumbar cistern drainage.Results The infections of 11 patients were effectively controlled after the treatment.The time from operation to infection ranged from 5 days to 11 days,with an average of(7.46±1.75) days.The anti-infection period of 11 patients ranged from 14 days to 23 days,with an average of(19.55±2.73) days.The time for leukocyte level in CSF to return to normal ranged from 10 dyas to 19 days,with an average of(15.27±3.58) days.The time for quantification of CSF glucose to return to normal ranged from 8 days to 16 days,with an average of(12.91±2.74) days.Conclusions For patients with CSFL associated with intracranial infection after the spinal surgery,the treatment methods should be selected according to the status of CSFL.Early diagnosis and control of infection are the key to successful treatment.Continuous lumbar cistern drainage combined with anti-infection is helpful in the treatment of patients with severe CSFL associated with intracranial infection.