用户名: 密码: 验证码:
持续腰大池引流技术在神经外科中的临床应用
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:探讨持续腰大池脑脊液引流技术在神经外科应用的临床价值。
     方法:回顾性分析2010年1月2011年2月间我科83例患者进行持续腰大池脑脊液引流治疗的临床资料,其中颅内感染24例,蛛网膜下腔出血26例,交通性脑积水10例,脑室积血9例,颅内占位12例,单纯脑脊液鼻漏2例。
     结果:持续腰大池脑脊液引流治疗24例颅内感染中,22例治愈,2例死亡;26例蛛网膜下腔出血患者治愈24例,2例死亡;10例脑积水患者,治愈8例,2例好转后行V-P分流术;9例脑室积血患者中1例好转,其余8例均治愈;12例颅内占位中,2例死亡,10例治愈。2例单纯脑脊液鼻漏患者均治愈。83例患者未发生因引流继发的颅内感染及脑疝等严重并发症,6例死亡均与置管引流无关。
     结论:持续腰大池脑脊液引流技术是一种安全、有效、微创的方法,可用于治疗颅内感染、蛛网膜下腔出血、交通性脑积水等神经外科常见病症。
     第二部分持续腰大池引流技术在锁孔手术围手术期中的应用31例分析
     目的:探讨持续腰大池脑脊液引流在神经外科锁孔手术围手术期中的临床应用价值。
     方法:回顾性分析2010年1月2011年2月间我科31例锁孔手术患者进行持续腰大池脑脊液引流治疗的临床资料,其中颅内动脉瘤21例,颅内占位10例。
     结果:持续腰大池脑脊液引流的31例锁孔手术患者中,21例颅内动脉瘤患者治愈20例,1例自动出院后死亡;10例颅内占位患者治愈9例,1例自动出院后死亡。31例患者未发生因引流继发的颅内感染及脑疝等严重并发症,2例死亡均与置管引流无关。
     结论:持续腰大池脑脊液引流技术是一种安全、有效、微创的方法,选择应用于锁孔手术围手术期很有价值。
Objective: To investigate the clinical value of the application of lumbar continuous drainage of fluid in neurosurgery.
     Methods: Retrospective analysis the clinical data of 83 cases which performed lumbar continuous drainage of fluid in our department from January 2010 to February 2011. including intracranial infection 24 cases, subarachnoid hemorrhage 26 cases, communicating hydrocephalus 10 cases, ventricle hematoma 9 cases, mass in intracranial 12 cases, cerebrospinal rhinorrhea 2 cases.
     Results: 22 cases were cured in the 24 cases of intracranial infection, 2 cases were dead. 24 cases were cured in the 26 cases of subarachnoid hemorrhage, 2 cases were dead. 8 cases were cured in the 10 cases of communicating hydrocephalus, and 2 cases were performed V-P shunt after improving. 8 cases were cured in the 9 cases of ventricle hematoma, 1 case discharged after improving. 2 cases were dead of the mass in intracranial 12 cases, and the 10 cases were cured. The 2 cases of cerebrospinal rhinorrhea were all cured. There is no severe complications ,such as intracranial infection and brain hernia, caused by lumbar continuous drainage of fluid. The 6 dead cases were independence with the lumbar continuous drainage of fluid.
     Conclusions: The lumbar continuous drainage of fluid is a safe、effective and micro-damage method. It can be used to treat many common diseases in neurosurgery, such as intracranial infection, subarachnoid hemorrhage, communicating hydrocephalus and so on.
     Objective: To investigate the clinical value of the application of lumbar continuous drainage of fluid in keyhole approach operations.
     Methods: Retrospective analysis the clinical data of 31 keyhole approach operations which performed lumbar continuous drainage of fluid in our department from January 2010 to February 2011.including intracranial aneurysm 21 cases, mass in intracranial 10 cases.
     Results : 1 case of intracranial aneurysms died after discharge,and the left 20 cases were cured. 1 case of mass in intracranial died and the others were cured. There is no severe complications, such as intracranial infection and brain hernia, caused by lumbar continuous drainage of fluid. The 2 dead cases were independence with the lumbar continuous drainage of fluid.
     Conclusions: The lumbar continuous drainage of fluid is a safe, effective and micro-damage method. It is valuable to be used in the keyhole approach operations .
引文
[1] Munch EC,Bauhuf C,Horn P,et a1.Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J].Crit Care Med,2001,29(5):976-981.
    [2] Requet F, Mann W J. lumbar cerebrospinal fluid drainage for prevention of cerebrospinal fluid fistulas [J].HNO,1993;41(7):335-338.
    [3]黄清海,刘建民,许奕,等.腰椎穿刺蛛网膜下腔置管持续引流防治血管痉的初步观察[J].第二军医大学学报,2001,22(8):784-786.
    [4] Borgmann R. Natural course of intercranial pressure and drainage of CSF after recovery from subarachnoid hemorrhage [J]. Acta Neurol Scand 1990;81(4): 300- 306.
    [5]余震,张入丹,王剑波,等.眶上锁孔入路切除鞍区肿瘤[J].中国微侵袭神经外科杂志,2009,14(12):551-552.
    [6]王忠诚.二十一世纪的神经外科学:微创神经外科学[J].中华神经外科杂志,2001,17:1.
    [7] Houle PJ, Vender JP, et al. Pump-regulated lumbar subarachnoid drainage [J]. Neurosurgery Rev,2000;46(4):929-932.
    [1] Munch EC,Bauhuf C,Horn P,et a1.Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J].Crit Care Med,2001,29(5):976-981.
    [2]黄清海,刘建民,许奕,等.腰椎穿刺蛛网膜下腔置管持续引流防治血管痉的初步观察[J].第二军医大学学报,2001,22(8):784-786.
    [3] Huang CI,Huang MC,Chen HI,et al. Diverse applications of continuous lumbar drainage of cerebrospinal fluid in neurosurgical patients[J]. Ann Acad MedSingapore.1993,22:456-458.
    [4]朱瑞,卞威,赵忠泽,等.持续腰大池引流配合超早期显微手术治疗47例颅内动脉瘤破裂临床分析[J].脑与神经疾病杂志,2010,18(1):27-29.
    [5]李国平,黄思庆,惠旭辉,等.289例持续腰池脑脊液引流在神经外科应用的临床总结[J].华西医学,2000,15(1):53-54.
    [6] Suzuki K,Meguro K,Sakurai T,et al.Endothelin-1 concentration increases in the cerebrospinal fluid in cerebral vasospasm caused by subarachnoid hemorrhage[J]. Surg-Neurl, 2000,53(2):131-135.
    [7] Dietrich HH, Dancey RG J r. Molecular keys to the problems of cerebral vasospasm [J]. Neurosurgery, 2000, 46: 517-530.
    [8]任红兵,宋伦贤,吴成亚,等.腰大池置管持续外引流治疗外伤性脑脊液漏[J ] .中国临床神经外科杂志,2005 ,10 (4) : 318-319.
    [9]顾征,徐爱民,孙永权,等.持续腰大池引流脑脊液的安全性及临床应用的探讨[J ] .脑与神经疾病杂志,2004 ,12 (1) :61-63.
    [10]余震,张入丹,王剑波,等.眶上锁孔入路切除鞍区肿瘤[J].中国微侵袭神经外科杂志,2009,14(12):551—552.
    [11]吴立平,张代龙,邓景阳.脑室外联合腰大池引流治疗脑室出血并发脑积水[J].中国微侵袭神经外科杂志,2010,15(7):304-305.
    [12]李峰.侧脑室及腰大池引流治疗脑室出血的应用探讨[J].中国现代药物应用,2009,3(4):112-113.
    [13] Houle PJ, Vender JP, et al. Pump-regulated lumbar subarachnoid drainage [J].Neurosurgery Rev,2000;46(4):929-932.
    [14]李战义,吕荣乾,翟晓慧,等.外伤性硬膜下积液和水瘤[J].中华神经外科杂志,1995,11:113-114.
    [1]兰青.神经外科锁孔显微手术的可行性及临床应用前景[J].实用肿瘤杂志,2007,22(4):286-287.
    [2] Munch EC,Bauhuf C,Horn P,et a1.Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J].Crit Care Med,2001,29(5):976—981.
    [3]黄清海,刘建民,许奕,等.腰椎穿刺蛛网膜下腔置管持续引流防治血管痉的初步观察[J].第二军医大学学报,2001,22(8):784—786.
    [4]郝继山,李旭东,梁恩和.前交通动脉瘤的显微治疗[J].中华神经医学杂志,2005,4(2):168-169
    [5] Kasuya H, Sh Imizut, Kagawa M. The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage: a retrospective analysis of 108 patients[ J] . Neurosurgery 1991, 28(1) : 56- 59.
    [6] Fishman A J, Hoffman R A, Roland JT Jr. Cerebrospinal fluid drainage in the management o f CSF leak following acoustic neuroma surgery [ J ] . Laryngoscope, 1996, 106 (8) : 1002 -1004.
    [7] Munch E C, Bauhuf C, Horn P, et al. Therapy of malignant in tracranial hypertension by controlled lumbar cerebrospinal fluid drainage[ J]. Crit Care Med, 2001, 29(5): 976- 981.
    [8]王玉宝,高寒,白红民,等.急诊显微外科手术治疗出血性脑动脉瘤[ J] .中华神经外科疾病研究杂志, 2005, 4(3): 220- 222.
    [9]陈谦学,吴立权,刘仁忠,等.颅内动脉瘤的显微手术治疗[ J] .中国临床神经外科杂志, 2008, 13 ( 7) : 388- 390.
    [10]于耀宇,马廉亭,秦尚振,等。腰大池持续引流不同时期犬脑脊液内皮素、一氧化氮变化与脑血管痉挛的关系[J].中国临床康复,2005,9(29):90-91.
    [11] H Irash Imy Y, Kur Imoto M, Hor I E, et al. Lower incidence of symptomatic vasospasm after subarachnoid hemorrhage owing to ruptured vertebrobasilaraneurysms [ J ] . Neurosurgery,2005, 57( 6) : 1110- 1116.
    [12]张更申,吴国彪,范振增,等.颅内破裂动脉瘤手术时机和预后关系[ J] .脑与神经疾病杂志, 2008, 16 ( 6) : 713- 715.
    [13]宋奎勤,李新钢.持续腰大池引流在神经外科的临床应用(附220例分析) [ J].中国临床神经外科杂志, 2008, 13( 1 ): 63.
    [14]喇新军,陈晨.腰大池置管持续引流治疗蛛网膜下腔出血[ J].临床医学, 2009, 29( 7) : 36- 37.
    [15]黄琦,蒋晓星.腰大池穿刺持续引流的临床应用及现状[J].中国微侵袭神经外科杂志,2003,8(12):571-573.
    [16] Mahajan R, Gupta R. Cerebrospinal fluid physiology and cerebrospinal fluid drainage[J].Ansthesiology,2004,100(6):1620.
    [17]李国平,黄恩庆,惠旭辉,等.289例持续腰池脑脊液引流在神经外科的临床总结[J].华西医学,2000,15(1):53-54.
    [18]黄清海,刘建民,辛涛,等.腰池持续引流防治蛛网膜下腔出血后脑血管痉挛的作用机制[J].介入放射学杂志,2004,12(2):10-14.
    [19] Ohwaki K, Yano E, Nakagomi T,et al. Relationship between shunt-dependent hydrocephalus after subarachnoid hemorrhage and duration of cerebrospinal fluid drainage[J].Br J Neurosurg,2004,18(2):130-134.
    [1]姜洪池,孙备.正确应用外科引流[J].临床外科杂志,2000,8(6):325—326.
    [2]吴孟超,吴在德.黄家驷外科学(第七版)[M],北京:人民卫生出版社,2008:183—187.
    [3]王忠诚.王忠诚神经外科学[M].武汉:湖北科学技术出版社,1998:1088—1089.
    [4]姚洁民,梁承钢.脑积水的研究进展[J].中国现代医生,2007(45)13:141—144.
    [5]王建一,邵强,岑波等.双侧侧脑室外引流治疗脑室内铸型出血21例[J].中国临床研究,2010,23(9):775—776.
    [6] Darby DG, Donnan GA, Saling MA, et al. Primary intraventricular hemorrhage: clinical and neuropsychological finding in a prospective stroke series[J] . Neurology, 1988, 38( 1) : 68—75.
    [7]孙瑾,田新华,张俊卿.脑室外引流合并Ommaya储液囊植入治疗自发性脑室内出血20例[J].中国临床神经外科杂志,2009,14(12):772-773.
    [8] Munch EC,Bauhuf C,Horn P,et a1.Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage[J].Crit Care Med,2001,29(5):976—981.
    [9]黄清海,刘建民,许奕,等.腰椎穿刺蛛网膜下腔置管持续引流防治血管痉的初步观察[J].第二军医大学学报,2001,22(8):784—786.
    [10] Borgmann R. Natural course of intercranial pressure and drainage of CSF after recovery from subarachnoid hemorrhage [J]. Acta Neurol Scand 1990 ,81(4):300-306.
    [11]余震,张入丹,王剑波等.眶上锁孔入路切除鞍区肿瘤[J].中国微侵袭神经外科杂志,2009,14(12):551—552.
    [12] Houle PJ, Vender JP, et al. Pump-regulated lumbar subarachnoid drainage [J].Neurosurgery Rev,2000,46(4):929-932.
    [13]田恒力,周良辅,徐涛.创伤性蛛网膜下腔出血并发脑积水危险因素分析[J].中国神经精神疾病杂志, 2006, 32 (3) : 220—223.
    [14]常书锋,郑鲁,楚燕飞,等.外伤性脑积水101例诊治体会[J].中国临床神经外科杂志, 2008, 13 (4) : 242—243.
    [15]陈向林.腹腔镜辅助脑室-腹腔分流术治疗脑积水34例临床分析[J].临床探讨,2010,48(15):103—104.
    [16]滕宏伟,薛新潮.脑室-腹腔分流术后并发症及其处理[J].交通医学,2008,22(5):532-533.
    [17] K an P, Walker ML, Drake JM , et al. Predicting slike ventricles in children on the basis of baseline characteristics at the time of shunt insertion. J Neuosurg,2007,106(5 Supp l): 347—349.
    [18]王鹏,张方成.裂隙脑室综合征[J].国际神经病学神经外科学杂志,2008,(35)3:239—241.
    [19] Rainov N, Schobess A, Heidecke V, et al. Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature[J]. Acta Neurochir(Wien), 1994,127(1-2): 73.
    [20] Sathyanarayana S, Wylen EL, Baskaya MK, et al. Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases [ J ]. Surg Neurol, 2000, 54 (5) :388–396.
    [21] Laligan NS,John M,Norman G. Malfunctioning ventriculoperioneal shunts[J]. Clinical and pathological features. Neurosurgery,1982,56:411-416.
    [22]李国平,甘渭诃,郑慧娜等.脑室镜引导下脑室腹腔分流术的临床应用体会[J].中国实用医药,2009(4)28:39—40.
    [23]王志刚,张纪庆等.改良脑室-心房分流术治疗脑积水[J].中国微侵袭神经外科杂志,2007,12( 8):344—346.
    [24] Chumas PD,Kulkarni MD,Drake JM,et al. Lumbar-peritoneal shunting: a retrospective study in the pediatrie population[J]. Neurosurg,1993,32(2):376.
    [25]张楷文,曹德晨等.腰大池—腹腔与脑室—腹腔分流术的对比[J].创伤外科杂志,1999,1(4):216—218.
    [26]陈大伟,顾卫宏等,L—P分流术治疗老年特发性正常压力脑积水[J].中华实用诊断与治疗杂志,2008 ,22 (11):859—860.
    [27]冯家丰.体外可调压分流管经皮穿刺腰大池-腹腔分流术治疗交通性脑积水[J].中国临床神经外科杂志,2010(15)1:15—17.
    [28]李战义,吕荣乾,翟晓慧等.外伤性硬膜下积液和水瘤[J].中华神经外科杂志,1995,(11):113-114.
    [29]刘玉光,贾涛,刘猛等.外伤性硬膜下积液的分型与临床特点[J].中华外科杂志,2003(41)10:763—765.
    [30]张定平,谭绪云,袁岱军等.硬膜下腔例[J].中华神经外科疾病研究杂志,2008,7(1):82-83.
    [31]陶志强,刘伟国.外伤性硬膜下积液研究进展[J].中国临床神经外科杂志,2006, 11(6):379-381.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700