脊柱术后脑脊液漏的手术治疗

目的 探讨脊柱术后脑脊液漏的手术治疗效果.方法 2004年7月至2009年7月,我科共手术治疗7例脑脊液漏患者,其中1例发生在胸椎后路手术,6例发生于腰椎后路手术.患者年龄47～73岁,平均64.7岁;其中男5例,女2例.脑脊液漏7例患者均经保守治疗（采用体位治疗、拔除引流、加压包扎）,其中5例脑脊液引流持续5 d在50 ml以上,夹闭或拔除引流后出现神经症状,1例为患者在拔除引流管后,引流管口形成窦道,14 d后脑脊液漏仍未停止.1例出院3 d后,用力时突然出现神经症状,保守无效.结果 7例患者均进行了切开硬脊膜修补术,其中4例单纯硬脊膜细线缝合,2例取筋膜补片修补,1例使用人工硬脊膜修补.7例患者均症状消失,痊愈.本组病例中无一例出现感染.结论 对于脊柱术后出现脑脊液漏患者,经严格保守治疗效果不佳后,及时手术治疗是安全有效的.

Surgical treatment of leakage of cerebrospinal fluid after spinal operation

Objective To investigate surgical treatment of leakage of cerebrospinal fluid after spinal operation. Methods There were 7 patients with leakage of cerebrospinal fluid treated by operation from July 2004 to July 2009, including 1 case after thoracic vertebra posterior approach operation and 6 cases after lumbar posterior approach operations. The average age iwas 64.7 years (47-73). Seven patients failed with conservative measurement (adopting body position treatment, pulling out the drainage and pressure dressing ). Sinus tract formed in 1 case after the tube pulled out and two weeks later the sinus failed to heal. The leakage of cerebrospinal fluid happened in 1case. Conservative treatment failed in all 7 cases. Results In all the 7 patients, incision exploration and dural repairs were performed. 4 cases were sutured with sting, 2 cases had fascia patch, 1 case hadartificial dura. There was no one infection in this group. Conclusion Surgical treatment is aneffective method to treat the leakage of cerebrospinal fluid after spinal operation while failed conservative treatments.