脊柱手术致脑脊液漏的处理方法探讨

目的：探讨脊柱手术中发生脑脊液漏的处理方法，对比分析两种处理方法的临床效果。方法：选择2010～2015年间我科室120例脊柱手术致脑脊液漏患者，将其随机分为观察组与对照组，每组各有60例，其中观察组给予 EC 耳脑胶结合阔筋膜术中进行封堵，再放置明胶海绵保护硬脊膜；对照组给予直接丝线连续缝合，再用筋膜、明胶海绵覆盖保护硬脊膜。两组术后均放置伤口引流管经椎旁肌由切口旁引出，再接无菌负压引流袋低位引流。观察比较两组患者术后引流量、拔管时间以及脑脊液漏、伤口脑脊液渗、皮下积液、头痛、伤口感染、颅内感染的发生情况。结果：观察组术后引流（257.3±46.2）mL，拔管时间（2.75±1.13）d，均少于对照组的（524.6±83.3）mL 和（7.05±1.68） d，差异具有统计学意义。观察组术后发生脑脊液漏、头痛、伤口脑脊液渗、皮下积液、伤口感染、颅内感染的例数分别是2例、2例、3例、1例、1例、0例，对照组术后发生脑脊液漏、头痛、伤口脑脊液渗、皮下积液、伤口感染、颅内感染的例数分别是9例、8例、10例、3例、2例、0例，观察组术后并发症发生率低于对照组。结论：EC 耳脑胶结合阔筋膜、明胶海绵术中封堵处理脊柱手术致脑脊液漏的效果优于直接丝线连续缝合+筋膜、明胶海绵覆盖。

Discussion of Effects and Complications from Two Methods on Cerebrospinal Fluid Leakage after Spinal Surgery

Objective To discuss the treatments of cerebrospinal fluid leakage after spinal surgery by comparing the clinical efficacy of two different methods. Methods 120 cases of cerebrospinal fluid leakage after spinal surgery in our department from 2010 to 2015 were divided into observation group and control group randomly, 60 cases in each group. The patients in observa-tion group were occluded by EC glue combined with fascia lata and the spinal dura mater was protected by gelatin sponge. The patients in control group were treated with continuous suture and the spinal dura mater was protected by gelatin sponge with fascia. All the patients were treated with wound drainage, the drainage tube were leaded from paraspinal muscles to incision and connected the sterility vacuum drainage bag. The volume of drainage, extubation time and complications after surgery were compared between two groups. Results In observation group, the volume of drainage was (257.3±46.2)ml and extubation time was(2.75±1.13)d which were lower than control group’s(524.6±83.3)ml and 7.05±1.68)d, all the differences were statistical significance.9 cases in observation group have complications. 32 cases in control group have complications. The rate of com-plication in observation group was lower than control group’s. Conclusion The efficacy of EC glue combined with fascia lata and the spinal dura mater treated on cerebrospinal fluid leakage after spinal surgery was better than continuous suture with silk suture and the spinal dura mater.