术中枕大池置管引流防治Chiari畸形术后并发症

摘要

目的 观察术中枕大池置管引流对防治Chiari畸形行枕大池扩大重建术后早期并发症的疗效.方法 回顾分析61例Chiari畸形行枕大池扩大重建术的病例资料,根据术中是否行枕大池置管引流分为置管组(29例)和对照组(32例),术前两组病例性别、年龄、基本病情差异无统计学意义(P>0.05).对比两组术后并发症、术后3 d脑脊液白细胞数、术后住院天数.结果 置管组均顺利置管,无继发永久神经损害症状.置管组术后出现并发症4例(13.79％),其中单纯发热3例,发热合并切口愈合不良1例,脑脊液检查排除中枢感染.对照组术后出现并发症12例(37.5％);其中单纯发热7例,中枢感染发热1例,中枢感染发热合并脑脊液漏与切口愈合不良2例,单纯切口愈合不良2例.置管组与对照组的术后3d脑脊液白细胞计数分别为(49.49±30.86)×106/L和(190.10±169.35)×106/L,术后住院时间分别为(8.2±2.1)d和(13.3±4.9)d.术后并发症、脑脊液白细胞计数、术后住院天数,两组比较差异具有统计学意义(均P<0.05).结论 术中枕大池置管引流安全可行,可加速脑脊液廓清,有效减少Chiari畸形行枕大池扩大重建术后早期并发症发生,缩短住院时间.%Objective To study the cli nical effic acy of cisterna magna drainage placed in the Chiari malformation operations for prevention of early postoperative complications. Methods The clinical data of 61 patients undergoing reconstruction of the cistern magna Chiari malformation were analyzed retrospectively. These patients were divided into the drainage group (n=29) and the control group ( n = 32 ) according to whether cisterna magna drainage was placed during the operation or not . There were no significant differences in sex , age and basic disease between the two groups before operation ( P > 0 . 05 ) . The postoperative complications , cerebrospinal fluid (CSF) leukocyte count and time of the postoperative hospital stay were compared between the two groups. Results The drainage placements were successfully performed in drainage group, without any permanent neural function damage. In the drainage group, postoperative complications occurred in 4 cases (13.79％), including only fever in 3 and fever and poor wound healing in 1 patient. No intracranial infection occurred by CSF examination. In the control group, postoperative complications occurred in 12 cases (37.5％), including only fever in 7, fever and intracranial infection in 1, fever, intracranial infection, CSF leakage and poor wound healing in 2, and only poor wound healing in 2. The CSF leukocyte count was (49.49 ± 30.86) × 106/L in the drainage group and (190.10 ± 169.35) × 106/L in the control group. The postoperative hospitalization time was (8.2 ± 2.1) days in the drainage group and (13.3 ± 4.9) days in the control group. The statistically significant differences were found in postoperative complications, CSF leukocyte count and postoperative hospitalization time between the two groups (all P<0.05). Conclusions Cisterna magna drainage in the operation is safe and feasible, can effectively accelerate the CSF clearance, reduce the incidence of early complications, shorten the days of hospital stay for the patients undergoing reconstruction of the cistern in the Chiari malformation.