脑脊液切口漏的原因、治疗及预防

Causes and preventions and treatments of cerebrospinal fluid incision leakage

目的探讨神经外科中较常见并发症脑脊液切口漏的原因与防治措施。方法通过回顾性的方法对21例脑脊液切口漏患者的临床资料进行分析总结。结果21例患者除1例因颅内感染未能控制死亡外,其余20例愈合满意。结论脑脊液切口漏的发生与术后高分解代谢状态,并发外伤性脑积水、外伤性脑膨出,术中切口缝合张力过大,长期应用激素,并发颅内感染等均有一定关系。治疗包括控制感染、减少漏口继续漏液、漏口局部处理三个主要方面,给予足够的营养支持,术中尽量修补硬脑膜,放回骨瓣,保证皮缘血运良好,术后延迟拆线等可以预防脑脊液切口漏。

Objective To investigate the causes,preventions and treatments of cerebrospinal fluid(CSF) incision leakage in the neurosurgical patients.Methods Clinical data of our 21 patients in recent years with CSF incision leakage were analyzed retrospectively.Results All the patients except for one died of uncontrolled intracranial infection were successfully treated.Conclusion Many factors were revealed to be responsible for CSF incision leakage,for example,high catabolism,traumatic hydroceqhalus and traumatic encephalocele after operation,too much tension of stitching incision,using hermones for a long time,intracranial infection after operation,and so on.The treatments included three important aspects:to control infection,to reduce CSF leakage and to deal with the incision itself.Many others could prevent CSF leakage,which included offering enough nutritional surport,mending the hard meninx and putting back the skull slice during operation,guaranteeing edge of incision blood is well,delaying stitches remove,and so on.