硬膜不透水缝合法防治后颅窝开颅术后局部积液.docxVIP

硬膜不透水缝合法防治后颅窝开颅术后局部积液 徐伦山,许民辉, 邹咏文, 陈广鑫, 周 椿 (第三军医大学大坪医院野战外科研 究所神经外科 , 重庆 400042) 摘 要 : 目的 探讨后颅窝术后症状性颈枕部积液的防治经验。方法 收集 我科 2000年1月至 2007年1月收治的后颅窝开颅术后出现症状性枕颈部积液 23例患者,及2004年1月至2007年1月连续 113例采用硬膜不透水缝合法患 者的临床资料 , 评价不同处理方法局部积液情况。结果 早期反复穿刺引流及加 压包扎治愈 4例,经腰池置管引流治愈 7例,再次手术修补治愈 12 例。硬膜不透 水缝合法 113 例无症状性枕颈部积液发生。结论 硬膜不透水缝合法是防治后 颅凹开颅后脑脊液漏的有效方法。 关键词:后颅窝开颅 ;脑脊液漏;积液;预防;治疗 中图法分类号 :R615;R651. 11;R742. 701 文献标识码 :A Prevention and treatment of symptomatic cerebrospinal fluid leaks and pseudomen-ingocele after posterior fossa surgery XU Lun-shan,XUMin-hui,ZOUYong-wen,CHEN Guang-xin,ZHOU Chun(Department ofNeurosurgery,Institute ofSur- geryResearch,DapingHospital,ThirdMilitaryMedicalUniversity,Chongqing 400042,China) Abstract:Objective To summarize the experience during themanagementof cerebrospinal fluid(CSF)leak and pseudomeningocele after posterior fossa surgery.Methods During a seven-year period(Jan 2000 toJan 2007),the clinicalcourse of23 patients suffered from CSF leak and pseudomeningocele afterposterior fossacraniotomy atDapingHospitalwere reviewed.Results Overall resultswere quite satisfactory. Four patientsrecovered after repeated subcutaneous punctures and pressure dressing. CSF leakswere stopped in seven patients by closed lumbar subarachnoid drainage. Twelve patients underwent repeated surgical repair of theirleaks. No patients suffered ongoing or recurrent leakage after reoperation. The application of thesemanagement resulted in a total absence of CSF leaks and pseudomeningocele in 113 consecutive patients thereafter.Conclusion A watertightdural closure verified byValsalvamaneuver,with the addition ofmuscle pieces andtissue glue in a “plugging ”fashion,provides a simple and effective technique for the prevention ofCSF leakageor pseudomeningocele after posterior fossa surgery. Key words:posterior fossa craniotomy;cerebrospinal fluid fistula;pseudomeningocele;prevention;treatment 后颅窝由于位置低垂 , 对硬膜缝合及肌肉层缝合要求高 , 术后局部积液发生 率高, 达 6% ~17%[1],有时可形成张力性囊肿。术中防止脑脊液硬膜内外的沟通 采取重建硬膜屏障技术等有利于避免此并