脊髓脊膜膨出早期修补术后失败的再手术治疗

目的 探讨显微外科分离和术中电生理监护技术对脊髓脊膜膨出早期修补术后失败患再手术的治疗价值。方法 16例曾于出生3个月～5岁施行脊髓脊膜膨出早期修补术失败的患，因神经功能障碍进行性加重而再次接受显微手术，术中采用躯体感觉诱发电位仪观察与监测整个感觉通路的整合功能以及反射通路功能；术后2～3周对巨大皮肤缺损施行植皮手术。结果 术后12例患随访3个月～3年，8例轻度排尿、排便障碍或下肢无力，术后功能改善良好；2例严重下肢无力及感觉减退，术后症状明显改善；2例严重排尿障碍并已行膀胱造瘘，术后排尿感觉恢复，但尿控制功能未恢复。结论 对脊髓脊膜膨出早期修补术后失败的患，可根据其神经功能障碍情况，选择性地再次施行显微外科手术治疗，神经功能仍可获得不同程度的改善。

Reoperation for failed early repair of meningomyelocele

Objective To explore the value of reoperation with microsurgical exclusion under electrophysiological monitoring for failed early repair of meningomyelocele. Methods Sixteen patients, aged 3 months to 5 years, failed early repair of meningomyelocele were performed microsurgical reoperation due to progressive exacerbation of neurofunction. The integration function of whole sensory pathway and function of reflex pathway were monitored with somesthetic evoked potentiometer during operation. Dermatoplasty was performed for large area skin defect in 2 to 3 weeks postoperatively. Results Twelve patients were followed up for 3 months to 3 years postoperatively, the reoperation effects were as follows: excellent functional improvement in 8 cases with mild dysproia, urinary dysfunction or weakness of lower extremity; obvious improvement of symptoms in 2 patients with serious weakness of lower extremity and hypoesthesia; restore of uriesthesis in 2 patients with serious urinary dysfunction and had been performed cystostomy but no improvement in urinary control function. Conclusion The neurofunction might be improved in different extent in patients failed early repair of meningomyelocele by selective microsurgical reoperation according to their patterns of neurofunction disturbances.