持续蛛网膜下腔引流治疗硬脊膜假性囊肿的临床疗效

目的评价蛛网膜下腔脑脊液引流对硬脊膜假性囊肿的治疗效果。方法 2005年6月～2010年12月,本科3265例手术后出现症状性硬脊膜假性囊肿12例,男7例,女5例,年龄48～69岁,平均57.3岁,均为后路手术。其中胸椎4例,腰骶椎8例。发病时间2个月～3年,平均1.5年。随机将全部病例分为2组,A组7例行硬脊膜假性囊肿切除并硬脊膜修补术;B组5例采取硬脊膜假性囊肿切除并硬脊膜修补联合经皮蛛网膜下腔脑脊液引流术。统计学比较两组患者引流管留置时间。结果 A组7例病人手术后切口引流管留置时间6～10d（平均7.5d）,术后1例脑脊液自切口渗出,并发感染,控制感染后,联合经皮蛛网膜下腔脑脊液引流而治愈,2例术后出现囊肿复发,行二次手术硬脊膜假性囊肿切除并硬脊膜修补联合经皮蛛网膜下腔脑脊液引流而治愈,其余4例未见相关并发症,Ⅰ期愈合;B组5例病人手术后切口引流管留置时间为4～5d（平均为4.5d）,蛛网膜下腔引流导管留置时间为5～7d（平均5.5d）本组所有患者均未见脑脊液从伤口流出,无任何追加治疗,无逆行性感染。拔管后,对蛛网膜下腔引流管内壁进行细菌培养,结果均为阴性。术后伤口均Ⅰ期愈合,术后随访1～5年症状消失,无复发。结论采用直接硬脊膜假性囊肿切除并硬脊膜修补联合经蛛网膜下腔引流可以缩短切口引流管留置时间;且可避免复发及切口感染。有良好的临床应用价值,值得予以推广。

Clinical evaluation of performing subarachnoid cerebrospinal fluid drainage in the treatment of pseudomeningoceles

Objective To evaluate the clinical significance of using percutaneous subarachnoid cerebrospinal fluid（CSF） drainage in treatment of pseudomeningoceles.Methods From June 2005 to December 2010,a total of 3265 patients received spinal surgery in our department;however,12 cases（7 male,5 female） aged from 48 to 69 ys（mean 57.3 ys） were complicated with pseudomeningocele.Posterior approach were adopted in all 12 cases,including 4 thoracic and 8 lumbosacral cases.The onset time arranged from 2 ms to 3 ys（mean 1.5 ys）.12 patients were randomly divided into two groups,Group A patients received pseudomeningocele excision and dural repair（7 cases）;Group B patients received pseudomeningocele excision,dural repair and subarachnoid drainage（5 cases）.Result The wound drainage duration of group A arranged from 6 to 10 ds（mean 7.5 ds）.Only 4 cases obtained primary healing ;1 case was complicated with CSF leakage and infection which acquired antiinfective treatment and subarachnoid CSF drainage ;2 cases were complicated with pseudomeningocele which acquired secondary surgery of dural repair and subarachnoid CSF drainage.The wound drainage duration of group B arranged from 4 to 5 ds（mean 4.5 ds）,the subarachnoid CSF drainage duration arranged from 5 to 7 days（mean 5.5 days）.There was no CSF effusion,supplement therapy or retrograde infection.After extubation,bacteria cultures were performed and findings were all negative.All of the patients obtained primary healing and symptoms had been vanished after follow-up for 1 to 5 years with no recurrence.The drainage dudration difference between two groups was significant（P＆lt; 0.05）.Conclusion Resection of pseudomeningocele combined with dural repair and subarachnoid CSF drainage reduced the wound drainage duration,decreased the incidence of postoperative incision infection and relapse,which could be regarded as an ideal option in the treatment of pseudomeningocele.