腰椎内镜髓核摘除术硬脊膜损伤或脑脊液漏的原因分析及防治

目的探讨显微内镜下髓核除手术(microendoscopic discectomy，MED)并发硬脊膜损伤或脑脊液漏的原因及防治。方法回顾分析1999年12月～2003年12月我院452例MED手术15例发生硬脊膜损伤或脑脊液漏的临床资料。结果术中发现硬脊膜损伤13例，9例术后出现脑脊液漏；2例术中未发现硬脊膜损伤术后发生脑脊液漏。11例脑脊液漏经正规保守治疗后3～7d治愈，无1例发生脑脊髓膜炎，无继发深部感染。结论MED因其自身的特点，易发生硬脊膜损伤；术前仔细分析病例，术中具备一定的手术技巧，可以减少硬脊膜损伤的发生；术中对损伤硬脊膜及时堵塞或修补，术后采取正规保守治疗措施，脑脊液漏均可治愈。

Dural injuries and cerebrospinal fluid leakage in lumbar microendoscopic discectomy: Etiology, prevention and treatment

Objective To investigate causes, the prevention and the treatment of dural injuries and cerebrospinal fluid leakage in lumbar microendoscopic discectomy (MED). Methods A retrospective analysis was taken on records of 15 cases of dural injuries and/or cerebrospinal fluid leakage out of 452 cases of MED from December 1999 to December 2003 in this hospital. Results Dural injury was found intraoperatively in 13 cases, and postoperative cerebrospinal fluid leakage occurred in 9 of them. In other 2 cases, postoperative cerebrospinal fluid leakage happened without dural injury seen intraoperatively. The cerebrospinal leakage was cured by a 3~7 days of conservative treatment in all the 11 cases. No cerebrospinal meningitis or secondary infection was observed. Conclusions The operation of MED renders patients liable to develop dural injuries. Careful analyses before the surgery and skillful surgical techniques can reduce the incidence of dural injury to a rarity. The cerebrospinal fluid leakage can be cured by timely repair during the surgery and standardized conservative treatment after the operation.