小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛中的应用.doc

小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛中的应用 ====================================================================== ????????????????????? 作者：张丕宁 刘美霞 丁弘 王静 李环廷 【摘要】? 目的探讨小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛术中应用的可行性。方法三叉神经痛和面肌痉挛女性病人62例(观察组)，术前备皮仅理去手术区域的头发，术中先用外科贴膜贴于手术区及头发上，然后距切口线周围头发2 mm处剪去贴膜，用20 g/L碘酊擦试和体积分数0.75乙醇脱碘，消毒后再贴一层无菌手术贴膜，然后常规铺手术巾，铺完手术巾后再贴一层有引流袋的手术贴膜;以同期全部剃发备皮的病人106例作为对照。观察两组的切口愈合情况及抗生素应用时间。结果两组切口均无感染。观察组抗生素平均使用7.2 d，对照组抗生素平均使用6.8 d。结论小区域备头皮在微血管减压术治疗三叉神经痛和面肌痉挛术中应用是安全的。? 【关键词】? 小区域备头皮;减压术,外科;伤口愈合 　[ABSTRACT]ObjectiveTo assess the feasibility of preparation of a small-field scalp in microvascular decompression (MD) in the treatment of trigeminal neuralgia (TN) and the facial spasm (FP).MethodsSixty-two female patients with TN or FP undergoing MD received only small-field scalp preparation. At operation, the region of operation and hair were covered by a piece of surgery paste film, the film was snipped at 2 mm away around the incision, the operative field was sterilized with 20 g/L tincture of iodine and 75% alcohol, one more piece of the film was then covered, other preparations were done as routine. After that,another film with drainage pack was sticked. A control group consisted of 106 patients of the same period whose hair were wholly shaved.ResultsNo incision was infected in both groups. Antibiotics were applied for average 7.2 days in observation group, in control group, 6.8 days.　　ConclusionA small-field scalp preparation in MD for trigeminal neuralgia and facial spasm is safe. 　　[KEY WORDS]small field scalp preparation; decompression, surgical; wound healing 　　国内传统的神经外科手术前，为了减少感染的发生，强调术前备皮要剃除整个头部毛发。这个传统一直延续到今天仍广泛被采用。但在国外，随着显微手术和锁孔手术的开展，术前对头部毛发的准备已不再要求全部剃光，而是针对特定手术部位实行局部备皮，这样既减轻了病人(尤其是女性病人)由于剃光头带来的心理恐惧，又降低了手术后佩戴假发所带来的经济负担[1]。2005年5月—2010年5月，我院应用微血管减压术治疗三叉神经痛和面肌痉挛病人168例，其中62例女性病人应用小区域备头皮，取得了良好的效果。现将结果报告如下。 　　1资料和方法 　　1.1一般资料 　　观察组病人62例，全部为女性，年龄41～75岁，平均54.3岁;其中三叉神经痛46例，面肌痉挛16例。均行微血管减压术治疗，其中经左侧乙状窦后入路手术40例，经右侧乙状窦后入路手术22例。以同期全部剃光头发的106例三叉神经痛和面肌痉挛病人作为对照组，其中男78例，女28例。 　　1.2备皮方