加压包扎联合微波治疗腰椎手术后脑脊液漏

目的探讨缝合加压包扎联合微波治疗腰椎手术后并发脑脊液漏的临床效果。方法 27例腰椎术后并发脑脊液漏的患者分为3组进行治疗,A组(10例)进行单纯引流,B组(7例)行缝合后加压包扎,C组(10例)行缝合加压包扎缝合联合微波局部伤口治疗,记录治疗前脑脊液日平均引流量、治疗后脑脊液漏停止时间、伤口愈合级别、脑脊液漏相关并发症的发生,并进行统计分析。随访4个月至5年。结果三组患者治疗前脑脊液平均日引流量分别为(378.5±53.0)ml、(379±57.0)ml、(369±55.0)ml,无统计学差异(P>0.05);三组脑脊液漏停止时间分别为(12.4±5.0)d、(7.9±2.2)d、(6.0±1.4)d,三组间差异有统计学意义(P<0.05);A组切口乙级愈合8例,丙级愈合2例,B组、C组均为乙级愈合。三组中无中枢神经系统感染。随访4个月至5年,A组有1例出现硬膜外脑脊液囊肿。结论加压包扎联合微波是治疗腰椎术后脑脊液漏的有效方法。

Pressure dressing suture combined with microwave ablation in treatment of cerebrospinal fluid leakage after lumbar spine surgery

Objective To study the effect of pressure dressing suture combined with microwave ablation in treatment of cerebrospinal fluid（CSF） leakage after lumbar surgery.Methods A total of 27 patients suffered from CSF leakage after lumbar spine surgery were allocated into 3 groups depending on 3 different treatment methods,patients in group A（n=10） were treated with delayed wound drainage,patients in group B（n=7） were treated with pressure dressing suture and patients in group C were simultaneously treated with pressure dressing suture and microwave ablation.The average amount of daily drainage of CSF before treatment,the duration of leakage,the grade of wound healing and CSF leakage related complications were recorded for statistical analysis.The duration of follow-up was 4 months to 5 years.Results Among these 3 groups,the average daily amount of drainage was 378.5±53 ml,379±57 ml and 369±55 ml respectively,and there was no statistical difference among these 3 groups（P0.05）.The mean duration of leakage was 12.4±5d,7.9±2.2 d and 6.0±1.9d respectively,and there was statistical difference among these 3 groups（P0.01）.In group A,the wounds of 8 patients were healed with grade II and in 2 patients with grade III.The wounds of all patients in groups B and C were healed in grade II.There was no infection of central nerve system happened in patients of all these 3 groups.One patient in group A was complicated with epidural cerebrospinal fluid cyst within the follow-up period for 4 month to 5 years.Conclusion Pressure dressing suture combined with microwave ablation is an effective therapeutic method for CSF leakage after lumbar spine surgery.