全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2015 

胸腰椎后路手术并发隐性脑脊液漏治疗经验总结

DOI: doi:10.7507/1002-1892.20150124

Keywords: 隐性脑脊液漏, 胸腰椎后路手术, 引流

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的总结胸腰椎后路手术并发隐性脑脊液漏的治疗经验,探讨切口部位引流管留置最佳时间,分析降低脑脊液切口漏出风险的方法。 方法回顾性分析2011年1月-2013年1月,胸、腰椎后路手术后发生隐性脑脊液漏的26例患者临床资料。男15例,女11例;年龄36~59岁,平均48.7岁。术后出现头痛19例;恶心5例,其中呕吐3例。23例引流管通畅、术后2 d内无脑脊液从皮肤切口漏出者,于第3天行夹闭引流管试验,其中21例无脑脊液切口漏出并拔管;2例出现脑脊液切口漏出,保守处理后第10天拔管。3例术后2 d内出现脑脊液切口漏出且保守处理无效者,再次手术清创、缝合切口,并留置引流管,术后第3天明确无脑脊液切口漏出后拔管。患者拔管后继续卧床3~5 d。 结果患者切口均愈合,愈合时间7~15 d,平均8 d。无1例出现切口感染、持续性脑脊液漏等并发症。拔管后患者头痛、恶心、呕吐等症状均立即缓解。患者均获随访,随访时间12~24个月,平均16个月。6个月时MRI检查示手术部位无1例出现皮下硬脊膜假性囊肿。 结论切口缝合质量是预防胸腰椎后路手术并发隐性脑脊液漏的关键因素。在保证缝合质量的前提下,可于术后第3天拔管。拔管前行夹闭引流管试验明确有无脑脊液切口漏出,以减少拔管后脑脊液从手术切口漏出的风险

References

[1]  5. Raffa SJ, Benglis DM, Levi AD. Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft. Spine J, 2009, 9(4):e25-e29.
[2]  6. Bachmann G, Djenabi U, Jungehülsing M, et al. Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(11):1299-1302.
[3]  7. Cho JY, Chan CK, Lee SH, et al. Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine:the utilization of a volume-controlled pseudomeningocele. J Spinal Disord Tech, 2012, 25(4):E93-E102.
[4]  10. Volobuev AN, Tolstonogov AP. Features of viscous-fluid flow in an elastic pipeline. Journal of Engineering Physics and Thermophysics, 2009, 82(4):749-755.
[5]  1. Guerin P, EI Fegoun AB, Obeid I, et al. Incidental durotomy during spine surgery:incidence, management and complications. A retrospective review. Injury, 2012, 43(4):397-401.
[6]  2. Str?mqvist F, J?nsson B, Str?mqvist B, et al. Dural lesions in lumbar disc herniation surgery:incidence, risk factors, and outcome. Eur Spine J, 2010, 19(3):439-442.
[7]  3. Lotfinia I, Sayyahmelli S. Incidental durotomy during lumbar spine surgery. Neurosurgery Quarterly, 2012, 22(2):105-112.
[8]  12. Reddick AD, Ronald J, Morrison WG. Intravenous fluid resuscitation:was Poiseuille right? Emerg Med J, 2011, 28(3):201-202.
[9]  13. McPherson D, Adekanye O, Wilkes AR, et al. Fluid flow through intravenous cannulae in a clinical model. Anesth Analg, 2009, 108(4):1198-1202.
[10]  14. Song D, Park P. Primary closure of inadvertent durotomies utilizing the U-Clip in minimally invasive spinal surgery. Spine (Phila Pa 1976), 2011, 36(26):E1753-E1757.
[11]  4. Joseph V, Kumar GS, Rajshekhar V. Cerebrospinal fluid leak during cervical corpectomy for ossified posterior longitudinal ligament:incidence, management, and outcome. Spine (Phila Pa 1976), 2009, 34(5):491-494.
[12]  8. Washburn EW. The dynamics of capillary flow. Physical Review, 1921, 17(3):273-283.
[13]  9. Pirofsky B. The determination of blood viscosity in man by a method based on Poiseuille's law. J Clin Invest, 1953, 32(4):292-298.
[14]  11. Srivastava A, Sood A, Joy SP, et al. Principles of physics in surgery:the laws of flow dynamics physics for surgeons-Part 1. Indian J Surg, 2009, 71(4):182-187.
[15]  15. Clendenen SR, Pirris S, Robards CB, et al. Symptomatic postlaminectomy cerebrospinal fluid leak treated with 4-dimensional ultrasound-guided epidural blood patch. J Neurosurg Anesthesiol, 2012, 24(3):222-225.
[16]  16. Tosun B, Ilbay K, Kim MS, et al. Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery. Asian Spine J, 2012, 6(3):157-162.
[17]  17. Tafazal SI, Sell PJ. Incidental durotomy in lumbar spine surgery:incidence and management. Eur Spine J, 2005, 14(3):287-290.
[18]  18. Hawk MW, Kim KD. Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus, 2000, 9(1):e5.
[19]  19. Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery, 1992, 30(2):241-245.
[20]  20. Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg (Am), 1989, 71(7):984-987.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133