腰大池引流治疗颈椎肿瘤术后脑脊液漏

目的分析持续腰大池引流治疗颈椎肿瘤术后脑脊液漏的临床效果。方法回顾性分析第二军医大学附属长征医骨肿瘤科2013年7月—2015年12月收治的接受颈椎肿瘤手术的264例患者资料(术后转至上海开元骨科医院继续治疗),其中颈椎肿瘤术后发生脑脊液漏并行持续腰大池引流的患者47例。24例患者因积极一般治疗后症状无明显缓解、13例伤口渗液明显、2例疑似合并颅内感染、8例2周的一般治疗后引流量仍较大而分别选择行腰大池引流。记录置管时间及引流时间,观察伤口愈合情况。结果所有患者经持续腰大池引流治疗后均获痊愈。持续引流7~43 d,平均13.8 d,腰大池置管时间为1~19 d,平均7.1 d。随访中有2例出现脑脊液囊肿,给予患者局部穿刺引流并局部加压包扎后治愈,其余无严重并发症。结论颈椎肿瘤术后脑脊液漏患者行持续腰大池引流治疗能有效控制患者不适症状,有助于伤口愈合,可预防和治疗颅内感染等,疗效确切。

Continuous lumbar cistern drainage for treatment of cerebrospinal fluid leakage after neck tumor surgery

Objective To investigate the clinical effectiveness of continuous lumbar cistern drainage(CLCD) in treatment of cerebrospinal fluid leakage after neck tumor surgery. Methods From July 2013 to December 2015 264 patients with neck tumor operated in Changzheng Hospital of Secondary Military Medical University(transferred to Shanghai Kaiyuan Orthopaedics Hospital at post-operation). Forty-seven patients among them suffered from postoperative cerebrospinal fluid (CSF) leakage,and were treated by CLCD. The indications were as follows:24 patients showed no symptom improvement after general treatment;13 had incision seepage;2 had suspected intracranial infection;8 continued to have large-volume drainage after general treatment for 2 weeks. The intubation time and drainage time were recorded. The condition of wound healing was observed. Results All patients were cured by CLCD. The drainage time was 7-43 d,mean 13.8 d. The intubation time was 1-19 d,mean 7.1 d. Follow-ups found cerebrospinal fluid cyst in 2 patients,which were healed by local puncture, drainage and pressure dressing. Conclusion CLCD could effectively alleviate discomfort symptoms,prompt incision healing and prevent and treat intracranial infection with a definite therapeutic efficacy.