腰大池置管引流在神经外科围手术期中的临床应用
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摘要
目的:探讨腰大池置管引流在神经外科围手术期中的临床应用。方法:回顾分析59例患者在围手术期中应用腰大池置管引流的临床资料,分析总结腰大池置管引流在神经外科围手术期中应用的适应证及相关临床经验。结果:腰大池置管引流对正常颅压脑积水是否行脑室腹腔分流具有指导意义,在神经外科手术中能有效降低颅内压,在动脉瘤性蛛网膜下腔出血、颅脑术后脑脊液漏、开颅术后颅内感染及开颅术后硬膜下积液的治疗中疗效确切,本组无因腰大池置管引流而并发颅内积气、颅内出血及颅内感染的病例,仅1例去骨瓣减压的患者在置管引流后出现反常性脑疝,经相应治疗后恢复。结论:腰大池置管引流在神经外科围手术期中的应用安全有效。
Objective: To explore the clinical application of lumbar cerebrospinal fluid drainage(LCFD) during the perioperative period in the department of neurosurgery.Methods: We retrospectively analyzed the clinical data of 59 patients undergone LCFD during the perioperative period and summarize the indication and clinical experience.Results: LCFD could anticipate the effect of ventriculoperitoneal shunt before surgery, decrease intracranial pressure in surgery, which showed good curative effect in the aneurysmal subarachnoid hemorrhage, postoperative cerebrospinal fluid leakage, postoperative in-tracranial infection and subdural collection of fluid after craniotomy. No pneumocephalus, intracranial hemorrhage or intracranial infection occured. Paradoxical herniation was provoked in one patient with craniectomy and then recovered after treatment.Conclusion: The application of LCFD during the peri-operative period in the department of neurosurgery is effective and safe.
Objective: To explore the clinical application of lumbar cerebrospinal fluid drainage(LCFD) during the perioperative period in the department of neurosurgery.Methods: We retrospectively analyzed the clinical data of 59 patients undergone LCFD during the perioperative period and summarize the indication and clinical experience.Results: LCFD could anticipate the effect of ventriculoperitoneal shunt before surgery, decrease intracranial pressure in surgery, which showed good curative effect in the aneurysmal subarachnoid hemorrhage, postoperative cerebrospinal fluid leakage, postoperative in-tracranial infection and subdural collection of fluid after craniotomy. No pneumocephalus, intracranial hemorrhage or intracranial infection occured. Paradoxical herniation was provoked in one patient with craniectomy and then recovered after treatment.Conclusion: The application of LCFD during the peri-operative period in the department of neurosurgery is effective and safe.
引文
[1]刘春波,王穗暖,屈洪涛.腰大池引流对继发性脑积水分流术疗效预判的作用[J].临床神经外科杂志,2016,13(1):70-71.Liu CB, Wang SN, Qu HT. Preoperative lumbar drain in anticipating effect of V-P shunt for secondary hydrocephalus[J]. J Clin Neurosurg, 2016,13(1):70-71.
[2]崔健,刘旭.术前腰大池置管引流在后颅窝占位切除术中的意义[J].陕西医学杂志,2013,42(2):190-191.Cui J, Liu X. The significance of preoperative lumbar drain in the surgery of posterior cranial fossa mass[J].Shaanxi Medical Journal, 2013,42(2):190-191.
[3] Lauritzen M, Dreier JP, Fabricius M, et al. Clinical relevance of cortical spreading depression in neurologi-cal disorders:migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury[J]. J Cereb Blood Flow Metab, 2011,31(1):17-35.
[4]李文涛,魏艳,张斌飞,等.腰大池脑脊液持续引流对蛛网膜下腔出血患者预后影响的Meta分析[J].中华脑科疾病与康复杂志:电子版,2013,3(3):39-44.Li WT, Wei Y, Zhang BF, et al. Lumbar continuous drain of cerebrospinal fluid for patients with aneurysmal subarachnoid hemorrhage:a Meta-analysis[J]. Clin J Brain Dis Rehabil(Electronic Edition), 2013, 3(3):39-44.
[5] Auer LM, Mokry M. Disturbed cerebrospinal fluid cir-culation after subarachnoid hemorrhage and acute aneu-rysm surgery[J]. Neurosurgery, 1990,26(5):804-808.
[6] Xu N, Meng H, Liu T, et al. Continuous lumbar cis-tern drainage before surgical clipping for aneurysmal subarachnoid hemorrhage[J]. World Neurosurgery,2018, pii:S1878-8750(18)30107-4.
[7]练晓文,侯春艳,游恒星,等.开颅术后颅内感染的相关因素探讨及对策[J].中国临床神经外科杂志,2013,18(4):197-200.Lian XW, Hou CY, You HX, et al. Risk factors relat-ed to intracranial infection after craniotomy and its coun-termeasures[J]. Chin J Clin Neurosurg, 2013,18(4):197-200.
[8] Allen KP, Isaacson B, Purcell P, et al. Lumbar sub-arachnoid drainage in cerebrospinal fluid leaks after later-al skull base surgery[J]. Otology&Neurotology, 2011,32(9):1 522-1 534.
[9]田志华,茹小红.腰大池引流在神经外科疾病中应用112例体会[J].中国药物与临床, 2017, 17(8):1 178-1 180.Tian ZH, Ru XH. The application of lumbar drain in neurosurgical disease[J]. Chinese Remedies Clinics,2017,17(8):1 178-1 180.
[10] Pravin S, Ravi G, Ankur K, et al. Symptomatic con-tralateral subdural hygromas after decompressive crani-ectomy:plausible causes and management protocols[J].Journal of Neurosurgery, 2015,122(3):602-609.
[11]简志宏,刘佳,刘仁忠,等.去大骨瓣减压术后腰穿诱发反常性脑疝[J].武汉大学学报:医学版,2017,38(6):998-1 001.Jian ZH, Liu J, Liu RZ, et al. Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture[J]. Medical Journal of Wuhan University,2017,38(6):998-1 001.
[2]崔健,刘旭.术前腰大池置管引流在后颅窝占位切除术中的意义[J].陕西医学杂志,2013,42(2):190-191.Cui J, Liu X. The significance of preoperative lumbar drain in the surgery of posterior cranial fossa mass[J].Shaanxi Medical Journal, 2013,42(2):190-191.
[3] Lauritzen M, Dreier JP, Fabricius M, et al. Clinical relevance of cortical spreading depression in neurologi-cal disorders:migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury[J]. J Cereb Blood Flow Metab, 2011,31(1):17-35.
[4]李文涛,魏艳,张斌飞,等.腰大池脑脊液持续引流对蛛网膜下腔出血患者预后影响的Meta分析[J].中华脑科疾病与康复杂志:电子版,2013,3(3):39-44.Li WT, Wei Y, Zhang BF, et al. Lumbar continuous drain of cerebrospinal fluid for patients with aneurysmal subarachnoid hemorrhage:a Meta-analysis[J]. Clin J Brain Dis Rehabil(Electronic Edition), 2013, 3(3):39-44.
[5] Auer LM, Mokry M. Disturbed cerebrospinal fluid cir-culation after subarachnoid hemorrhage and acute aneu-rysm surgery[J]. Neurosurgery, 1990,26(5):804-808.
[6] Xu N, Meng H, Liu T, et al. Continuous lumbar cis-tern drainage before surgical clipping for aneurysmal subarachnoid hemorrhage[J]. World Neurosurgery,2018, pii:S1878-8750(18)30107-4.
[7]练晓文,侯春艳,游恒星,等.开颅术后颅内感染的相关因素探讨及对策[J].中国临床神经外科杂志,2013,18(4):197-200.Lian XW, Hou CY, You HX, et al. Risk factors relat-ed to intracranial infection after craniotomy and its coun-termeasures[J]. Chin J Clin Neurosurg, 2013,18(4):197-200.
[8] Allen KP, Isaacson B, Purcell P, et al. Lumbar sub-arachnoid drainage in cerebrospinal fluid leaks after later-al skull base surgery[J]. Otology&Neurotology, 2011,32(9):1 522-1 534.
[9]田志华,茹小红.腰大池引流在神经外科疾病中应用112例体会[J].中国药物与临床, 2017, 17(8):1 178-1 180.Tian ZH, Ru XH. The application of lumbar drain in neurosurgical disease[J]. Chinese Remedies Clinics,2017,17(8):1 178-1 180.
[10] Pravin S, Ravi G, Ankur K, et al. Symptomatic con-tralateral subdural hygromas after decompressive crani-ectomy:plausible causes and management protocols[J].Journal of Neurosurgery, 2015,122(3):602-609.
[11]简志宏,刘佳,刘仁忠,等.去大骨瓣减压术后腰穿诱发反常性脑疝[J].武汉大学学报:医学版,2017,38(6):998-1 001.Jian ZH, Liu J, Liu RZ, et al. Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture[J]. Medical Journal of Wuhan University,2017,38(6):998-1 001.