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目的探讨持续腰椎穿刺引流术在高位骶骨肿瘤切除术后脑脊液漏患者中的应用效果。方法采用回顾性对比分析方法。对1998年1月至2011年8月,就诊于我科行高位骶骨肿瘤切除术并有完整病例资料的72例进行分析。纳入标准为:骶骨肿瘤切除患者术中发生硬脊膜损伤且术后发生脑脊液漏的患者,同时排除有持续腰椎穿刺脑脊液引流禁忌证如脑疝、颅内压明显增高、穿刺部位皮肤或软组织感染、全身严重感染败血症或休克、穿刺不能合作、L_3以上脑脊液循环通路梗阻等情况的患者。最终符合纳入标准共11例。将2005年3月前行骶骨肿瘤切除术后发生脑脊液漏患者使用单纯伤口旁放置引流管引流的5例作为对照组,2005年3月以后行骶骨肿瘤切除术后发生脑脊液漏的6例为采用持续腰椎穿刺引流治疗组,分别对两组患者脑脊液漏治愈时间和患者一般情况及相关并发症进行对比研究。结果两组患者均无逆行性颅内感染发生,其中单纯放置引流管引流组1例发生手术切口局部感染。持续腰椎穿刺引流患者脑脊液漏愈合时间中位数为14.5(12~18)天,较对照组患者25(23~36)天缩短,两组差异有统计学意义(P=0.004)。腰椎穿刺引流组患者治疗期间骶尾部切口渗液少,肿胀明显较单纯引流组轻,患者自体感觉如伤口疼痛、头晕等症状较单纯引流组轻。两组患者均无低颅压性头痛、无进行性低颅压、气颅、脑疝等并发症发生。结论持续腰椎穿刺引流治疗骶骨肿瘤切除术后脑脊液漏较单纯伤口旁引流效果好,并且有效缩短脑脊液瘘口闭合时间。
Objective To investigate the effect of continuous lumbar puncture and drainage in patients with cerebrospinal fluid leakage after high sacral tumor resection. Methods Retrospective comparative analysis method. From January 1998 to August 2011, 72 patients who underwent high sacral tumor resection in our department with complete case data were analyzed. Inclusion criteria: patients with sacral tumor resection dura caused by intraoperative spinal drainage and cerebrospinal fluid leakage patients, while excluding continuous lumbar puncture cerebrospinal fluid drainage contraindications such as cerebral hernia, increased intracranial pressure, puncture site skin or soft tissue infections , Severe systemic infection with sepsis or shock, puncture can not cooperate, L_3 above cerebrospinal fluid circulation pathway obstruction and so on. The final inclusion of a total of 11 cases. In March 2005, 5 cases of cerebrospinal fluid leakage after cerebrospinal fluid leakage after radical resection of sacral tumor were treated with drainage tube placed just beside the wound as a control group. Six cases of cerebrospinal fluid leakage after sacral tumor resection were performed after March 2005 Continuous lumbar puncture drainage treatment group, respectively, two groups of patients with cerebrospinal fluid leakage healing time and the general situation of patients and related complications were compared. Results There was no retrograde intracranial infection in both groups. One of the patients who underwent drainage tube drainage alone had a partial surgical incision infection. The median time to healing of cerebrospinal fluid leakage in patients undergoing continuous lumbar puncture and drainage was 14.5 days (12-18 days), which was shorter than 25 (23-36) days in patients in control group. There was significant difference between the two groups (P = 0.004). Lumbar puncture drainage group patients during treatment of sacrococcygeal incision less effusion, swelling was significantly lighter than the simple drainage group, patients with self-feeling such as wound pain, dizziness and other symptoms than simple drainage group. No two patients had low intracranial pressure headache, no progressive low intracranial pressure, gas cranial hernia and other complications. Conclusions Continuous lumbar puncture and drainage for cerebrospinal fluid leakage after sacrectomy is better than simple wound drainage and shortens the closure time of cerebrospinal fluid fistula.