项韧带筋膜与人工硬脑膜在儿童硬脑膜修补中的效果分析

Comparison of the clinical effects of nuchal ligamentum fascia and artificial dura mater on dural repair in posterior fossa tumor resection in children

目的对比分析经枕下后正中入路切除儿童后颅窝肿瘤术中应用项韧带筋膜与人工硬脑膜修补硬脑膜的效果。方法回顾性分析2017年1月至2022年5月空军军医大学第二附属医院神经外科采用经枕下后正中入路切除后颅窝肿瘤患儿的临床资料,共63例。其中30例采用人工硬脑膜修补硬脑膜(人工脑膜组),33例采用自体项韧带筋膜修补硬脑膜(项韧带筋膜组)。比较两组患者的手术情况、术后并发症、住院时间和花费。结果项韧带筋膜组硬脑膜修补时间为(11.2±1.3)min,与人工脑膜组的(15.5±1.7)min比较,差异有统计学意义(P<0.05);两组手术时间差异无统计学意义(P>0.05)。人工脑膜组出现假性脑膜膨出4例(13.3%)、脑脊液漏5例(16.7%)、颅内感染4例(13.3%);项韧带筋膜组除1例(3.0%)患者发生颅内感染外,无一例患者发生假性脑膜膨出及脑脊液漏。两组患者假性脑膜膨出、脑脊液漏的发生率差异均有统计学意义(均P<0.05)。项韧带筋膜组的住院时间、住院总花费均低于人工脑膜组,差异均有统计学意义(均P<0.05)。63例患儿随访6~12个月,均未出现假性脑膜膨出和脑脊液漏。结论与采用人工硬脑膜相比,在经枕下后正中入路切除儿童后颅窝肿瘤术中采用项韧带筋膜修补硬脑膜,可降低假性脑膜膨出、脑脊液漏等并发症的发生率。

Objective To compare the clinical effects of nuchal ligamentum fascia and artificial dura mater on dural repair in posterior fossa tumor via suboccipital posterior midline approach in children.Methods The clinical data of 63 children who underwent intracranial tumor resection via suboccipital posterior midline approach in the Department of Neurosurgery,the Second Affiliated Hospital of Air Force Medical University from January 2017 to May 2022 were retrospectively analyzed.Among them,artificial dura mater was used in 30 cases(group A)and nuchal ligament fascia in 33 cases(group B).The clinical data,postoperative complications and efficacy of the two groups were compared.Results The dura suture repair time in the B group was(11.2±1.3)min,and there was a statistically significant difference compared to the A group(15.5±1.7)min(P<0.05).After operation,there were 4 cases(13.3%)of pseudomeningocele,5 cases(16.7%)of cerebrospinal fluid leakage,and 4 cases(13.3%)of intracranial infection in group A,and 1 case(3.0%)of intracranial infection in group B,and there was no pseudomeningocele or cerebrospinal fluid leakage in group B.The incidence of pseudomeningocele and cerebrospinal fluid leakage was statistically significant between the two groups(both P<0.05).The length of hospital stay and the total cost of hospitalization in group B were lower than those in group A,and the differences were statistically significant(both P<0.05).Sixty-three children were followed up for 6-12 months,and none of them had pseudomeningocele or cerebrospinal fluid leakage.Conclusion Compared with the use of artificial dura,the use of nuchal ligament fascia repair in children undergoing posterior fossa tumor resection via suboccipital posterior midline approach can reduce the incidence of complications such as pseudomeningocele and cerebrospinal fluid leak.