应用明胶海绵野三明治冶法在硬脊膜缝合后预防脑脊液漏的作用

 目的 探讨明胶海绵“三明治”法(医用胶+明胶海绵+医用胶)在加强硬脊膜后方裂口缝合预防脑脊液漏的作用。方法 回顾性分析2007年2月至2011年6月收治的54例椎管内硬脊膜下肿瘤患者资料,根据修复硬脊膜的方法将患者分成两组。常规修复组23例,男16例,女7例;年龄24～69 岁,平均(45.2±7.2)岁;“三明治”组31例,男19例,女12例;年龄22～67 岁,平均(44.2±6.4)岁。患者在切除椎管内硬脊膜下的肿瘤后,常规修复组采用连续锁边缝合硬脊膜后覆盖大小合适的明胶海绵;“三明治”组在连续锁边缝合硬脊膜后,加用医用胶喷涂缝合口及周缘硬脊膜,而后覆盖大小合适的明胶海绵,最后再次在明胶海绵表面及周缘喷涂医用胶。结果 与常规修复组比较,“三明治”组术后当天、第1天、第2天、第3天引流量均明显下降。常规修复组在引流管拔除后7～10 d仍有3例出现切口积液,经穿刺抽液、沙袋加压、俯卧体位等治疗后切口愈合。两组患者均获随访,随访时间12~63个月,平均26.5个月。常规组3个月后有5例伤口发生深部积液;“三明治”组未见明显异常。结论 应用“三明治”法修复硬脊膜背部损伤裂口可明显提高缝合修复效果,有效减少术后引流量,降低脑脊液漏发生率。

Use of gelatin sponge in "sandwich" method for prevention of cerebrospinal fluid leakage after repair of spinal dura mater

Objective To investigate the therapeutic effect of the "sandwich" method (medical glue +gelatin sponge+medical glue) in the repair of spinal dura mater to prevent the cerebrospinal fluid leakage. Methods From February 2007 to June 2011, 54 patients with spinal subdural tumors underwent excision of tumor in our hospital. According to manner of repairing spinal dura mater, all patients were classified into two groups: routine group and "sandwich" group. There were 16 males and 7 females with an average age of 45.2?7.2 years in the routine group, while 19 males and 12 females with an average age of 44.2?6.4 years in "sandwich" group. In routine group, the spinal dura mater was repaired through running locked suture. In "sandwich" group, the spinal dura mater was repaired through running locked suture, painting medical glue around the dural incision, covering with gelatin sponge, and painting medical glue on the surface and margin of gelatin sponge successively. Results Compared with the routine group, the total volume of postoperative drainage in "sandwich" group decreased significantly on the very day, the first day, the second day, and the third day, and the incidence of cerebrospinal fluid leakage decreased significantly. Before discharge, hydrops happened in 3 cases in the routine group, and got well through aspiration, continuous pressure by sandbag, and prone position. Three months after operation, 5 cases from the routine group got deep hydrops under the incision and no treatment was applied to them. There was no obvious abnormality in the "sandwich" group. Conclusion The "sandwich" method can improve the repair effect of spinal dura mater injury, reduce the volume of postoperative drainage, and decrease the incidence of cerebrospinal fluid leakage.