两种硬脊膜密封修复方式预防脑脊液漏的比较

Comparison of two dural sealing methods for prevention of cerebrospinal fluid leakage

[目的]比较两种硬脊膜密封修复方式预防脑脊液漏的疗效。[方法]2015年1月—2018年12月手术治疗椎管内硬膜下肿瘤患者72例。其中,32例在肿瘤切除硬脊膜缝合后覆盖明胶海绵(明胶组),40例在肿瘤切除硬脊膜缝合后覆盖脂肪联合明胶海绵(复合组)。比较两组围手术期和随访结果。[结果]两组手术时间、术中出血量、硬脊膜切开长度和手术部位感染发生率差异均无统计学意义(P>0.05)。复合组术后引流量、引流时间、术后住院时间和脑脊液漏发生率均低于明胶组(P<0.05)。患者平均随访时间为(28.24±4.63)个月。随时间推移,两组VAS评分均显著减少(P<0.05)。在相同时间点,两组间VAS评分比较差异无统计学意义(P>0.05)。两组改良Macnab疗效评定结果比较差异无统计学意义(P>0.05)。[结论]对于椎管内硬膜下肿瘤患者,切除肿瘤并缝合硬脊膜后覆盖脂肪联合明胶海绵的临床效果优于覆盖明胶海绵。

[Objective]To compare the clinical outcomes of two dural sealing methods for prevention of cerebrospinal fluid leakage.[Methods]A retrospective study was conducted on 72 patients who underwent surgical treatment for intraspinal subdural tumors from Janu⁃ary 2015 to December 2018.Of them,32 patients received gelatin sponge coverage on the dural after tumor resection and dural suture(the GS group),while the remaining 40 patients underwent fat combined with gelatin sponge coverage on the dural(the combined group).The clinical results were compared between the two groups.[Results]There were no significant differences in operative time,intraoperative blood loss,length of dural incision and incidence of surgical site infection between the two groups(P>0.05).However,the combined group proved significantly superior to the GS group in terms of postoperative drainage volume,drainage time,postoperative hospital stay and inci⁃dence of cerebrospinal fluid leakage(P<0.05).As time went during the follow-up lasted for(28.24±4.63)months,the VAS scores in both groups decreased significantly(P<0.05),which proved not statistically significantly different between the two groups at any matching time points(P>0.05).In addition,there was no statistical significance in the clinical outcomes in term of modified Macnab criteria between the two groups(P>0.05).[Conclusion]For intraspinal subdural tumors resection,fat tissue combined with gelatin sponge coverage on dual is superior to the coverage with gelatin sponge only for prevention of cerebrospinal fluid leakage.