神经外科术后脑脊液漏的诊治体会.docVIP

精品论文 参考文献 神经外科术后脑脊液漏的诊治体会 黄山 程波 杨浩（ 四川夹江解放军4 2 医院外一科 6 1 4 1 0 0 ） 【摘要】目的 探讨神经外科术后脑脊液漏的诊断和治疗方法。方法 回顾性分析我院自1995年8月至2009年8月收治的43例神经外科术后脑脊液漏患者的资料,其中大脑半球手术15例,小脑手术19例, 椎管手术9例,12例经一般保守治疗治愈, 13例经脑脊液持续外引流治疗, 11例次开颅手术处理。结果 治愈31例，好转6例，无变化2例,未治8例。结论 术中严密缝合硬脑膜或硬脊膜，彻底解除术区压力是预防术后脑脊液漏的关键,早期确诊和合理选择治疗方案有助于改善神经外科术后脑脊液漏的预后。 【关键词】神经外科 手术 脑脊液漏 【中图分类号】R619 【文献标识码】B 【文章编号】2095-1752（2012）01-0297-02 Diagnosis and treatment of cerebrospinal fluid leakage after neurosurgery Huang shan Department of Neurosurgery, 42 hospital of PLA,Jiajiang Sichuan,614100 【Abstract】Objective To investigate diagnosis and treatment of cerebrospinal fluid leakage after surgery. Methods Retrospectively analysis the 43 cases of CSF leakage in our hospital from August 1995 to August 2009. In the cases, 15 patients were treated by cereral surgery, 19 were treated by cerebellum surgery and 9 of vertebrae surgery. In the study, 12 patients were cured through the expectant treatment, 13 were cured through the CSF drainage and 11 cases used the craniotomy surgeries. Results Among the 43 cases, 31 of them were cured, 6 gained improvement, while 2 had no change, 8 were not cure. Conclusion Early diagnosis and reasonable treatment can do help to cure the leakage of cerebrospinal.The key points to prevent the leakage are: Carefully sewing up the cerebral dura mater or spinal dura mater during the surgery and completely relieving the stresses of the operative region. 【Key words】neurosurgery surgery leakage of cerebrospinal 神经外科术后脑脊液漏指脑脊液经切口漏或经颅底筛窦、蝶窦、乳突形成鼻漏或耳漏，发生率1.4-7.2%不等[1,2]。因脑脊液漏可并发颅内感染，对患者的死、残等预后具有潜在的风险，是开颅手术重要并发症。我院自1995年8月至2009年8月1537神经外科手术病例共发生脑脊液漏43例，发生率2.8%。现就其诊治过程进行回顾分析，报告如下。 1 临床???料与方法 1.1 一般资料 本组男28例，女15例；年龄7-68岁，平均43.3岁。大脑半球手术15例,小脑手术19例, 椎管手术9例。 1.2 治疗 12例经一般保守治疗，包括切口加固缝合、体位、脱水利尿等降颅压治疗措施治愈, 13例经腰池或脑室持续外引流治疗, 10例11例次开颅手术处理（一例行两次手术）。 2 结果 治愈31例，好转6例，无变化2例，未治8例。合并颅内或椎管内感染2例。 3 讨论 3.1 诊断 有明确的手术史，多于术后一周左右发生，手术切口或鼻、耳有水样液体流出，可伴