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目的探讨腰大池引流技术对脊柱哑铃型肿瘤术后脑脊液漏及相关并发症的影响,了解该技术的实用性。方法选取2012年2月至2014年10月,我科采用早期腰大池引流技术治疗的77例脊柱哑铃型肿瘤术后脑脊液漏患者作为治疗组,其中男42例,女35例,年龄16~74岁,平均48.6岁;选取2010年1月至2012年3月,引入腰大池引流技术前的71例同类患者作为对照组,其中男41例,女30例,年龄12~77岁,平均46.7岁。收集两组患者创口感染、创口不愈合、创区波动性隆起、迟发性创口开裂、持续性头痛、术后短暂性发热、顽固性发热的发生情况及腰大池引流前后创口引流量变化情况,并进行统计学处理。结果对照组77例中,术后创口感染6例,创口不愈合14例,创区术后出现波动性隆起13例,迟发创口开裂6例,持续性头痛不适37例,短暂性发热40例,顽固性发热9例;治疗组71例中,术后创口感染1例,创口不愈合2例,创区波动性隆起2例,迟发性创口开裂1例,持续性头痛4例,短暂性发热13例,顽固性发热1例。对照组拔管前引流量(238±65)ml,创口引流管拔管天数(14.2±2.3)天;治疗组腰大池置管术前创口引流量(296±80)ml,腰大池引流后第2天引流量(103±31)ml,拔管前引流量(48±15)ml,创口引流管拔除天数(8.9±1.8)天。治疗组创口相关并发症的发生率、拔管前创口引流量、拔管天数均小于对照组,差异有统计学意义(P<0.05)。结论早期腰大池引流技术对于脊柱哑铃型肿瘤术后脑脊液漏治疗及相关并发症预防具有重要的临床价值,可以减少切口相关并发症、脑脊液漏相关发热、脑脊液皮下囊肿等不利情况发生。
Objective To investigate the effect of lumbar cistern drainage on cerebrospinal fluid leakage and related complications after spinal dumbbell tumor and to understand the practicability of the technique. Methods From February 2012 to October 2014, 77 patients with postoperative cerebrospinal fluid leakage of spinal dumbbell tumor treated by early lumbar drainage were selected as the treatment group, including 42 males and 35 females, aged from 16 to 74 Years old, average 48.6 years old; selected from January 2010 to March 2012, the introduction of lumbar drainage before 71 cases of similar patients as a control group, including 41 males and 30 females, aged 12 to 77 years, mean 46.7 years . The incidence of wound infection in the two groups of patients, wound nonunion, undulation of invasive zone, protracted wound dehiscence, persistent headache, postoperative transient fever and intractable fever were observed. Changes of wound drainage before and after lumbar drainage were collected, And statistical analysis. Results In the control group of 77 cases, postoperative wound infection was performed in 6 cases and non-wound wound in 14 cases. There were 13 cases of fluctuating bumps, 6 cases of delayed wound dehiscence, 37 cases of persistent headache discomfort, and 40 cases of transient fever , Intractable fever in 9 cases; treatment group 71 cases, postoperative wound infection in 1 case, wound nonunion in 2 cases, 2 cases of fluctuating hemorrhage, delayed open wound in 1 case, persistent headache in 4 cases, transient 13 cases of fever, intractable fever in 1 case. In the control group, drainage volume (238 ± 65) ml and drainage tube extubation days (14.2 ± 2.3) days before extubation were achieved in the control group. The drainage volume of the wound before operation in the lumbar drainage group was 296 ± 80 ml, The drainage volume was (103 ± 31) ml for 2 days, 48 ± 15 ml for extubation and 8.9 ± 1.8 days for wound drainage. The incidence of wound-related complications in the treatment group, wound drainage and extubation days before extubation were all less than those in the control group, with significant differences (P <0.05). Conclusions Early lumbar drainage for drainage of cerebrospinal fluid in patients with spinal dumbbell tumor may have important clinical value in preventing postoperative complications of spinal ducts, and may reduce the incidence of incision-related complications, cerebrospinal fluid leakage-related fever, and subcutaneous CSF of cerebrospinal fluid.