[1]蔡刚峰黄国河廖圣芳.脊柱外科术后脑脊液漏并颅内感染的诊治分析[J].中国临床神经外科杂志,2022,27(02):100-103.[doi:10.13798/j.issn.1009-153X.2022.02.010]
　CAI Gang-feng,HUANG Guo-he,LIAO Sheng-fang..Treatment of cerebrospinal fluid leakage associated with intracranial infection after spinal surgery[J].,2022,27(02):100-103.[doi:10.13798/j.issn.1009-153X.2022.02.010]
点击复制

脊柱外科术后脑脊液漏并颅内感染的诊治分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年02期
页码:
100-103
栏目:
论著
出版日期:
2022-02-25

文章信息/Info

Title:
Treatment of cerebrospinal fluid leakage associated with intracranial infection after spinal surgery
文章编号:
1009-153X（2022）02-0100-04
作者:
蔡刚峰黄国河廖圣芳
362000 福建泉州，中国人民解放军联勤保障部队第九一〇医院神经外科（蔡刚峰、黄国河、廖圣芳）
Author(s):
CAI Gang-feng;  HUANG Guo-he;  LIAO Sheng-fang.
Department of Neurosurgery, 910th Hospital of Joint Logistics Support Force,PLA, Quanzhou 362000, China
关键词:
脊柱外科; 颅内感染; 脑脊液漏; 腰大池引流术
Keywords:
Spine surgery;  Intracranial infection;  Cerebrospinal fluid leakage;  Lumbar cistern drainage
分类号:
R 651.1+1; R 619
DOI:
10.13798/j.issn.1009-153X.2022.02.010
文献标志码:
A
摘要:
目的 探讨脊柱外科术后脑脊液漏并颅内感染的治疗方案及临床疗效。方法回顾性分析2014年1月至2020年1月收治的11例脊柱外科手术后发生脑脊液漏并颅内感染的临床资料。5例单纯抗感染治疗，1例保持引流并抗感染治疗，5例抗感染联合腰大池引流治疗。结果11例感染均有效控制；术后至出现发热时间5~11 d，平均（7.46±1.75）d；抗感染周期14~23 d，平均（19.55±2.73）d；脑脊液白细胞水平恢复正常时间10~19 d，平均（15.27±3.58）d；脑脊液糖定量恢复正常时间8~16 d，平均（12.91±2.74）d。结论脊柱外科术后脑脊液漏并颅内感染，应根据脑脊液漏情况选择不同方案，早期发现并控制感染是治疗成功的关键。持续腰大池引流联合抗感染有助于渗漏严重病人的治疗。
Abstract:
Objective To investige the management and outcome of cerebrospinal fluid leakage (CSFL) associated withintracranial infection after the spinal surgery. Methods A retrospective analysis was performed on the clinical data of 11 patients withCSFL associated with intracranial infection after the spinal surgery. According to the severity of CSFL, 5 patients were treated withsimple anti-infection,1 was keeping the subcutaneous drainage tube and treated with anti-infection, 5 were treated with anti-infectioncombined with lumbar cistern drainage. Results The infections of 11 patients were effectively controlled after the treatment. The timefrom operation to infection ranged from 5 days to 11 days, with an average of (7.46±1.75) days. The anti-infection period of 11 patientsranged from 14 days to 23 days, with an average of (19.55±2.73) days. The time for leukocyte level in CSF to return to normal rangedfrom 10 dyas to 19 days, with an average of (15.27±3.58) days. The time for quantification of CSF glucose to return to normal rangedfrom 8 days to 16 days, with an average of (12.91±2.74) days. Conclusions For patients with CSFL associated with intracranial infectionafter the spinal surgery, the treatment methods should be selected according to the status of CSFL. Early diagnosis and control ofinfection are the key to successful treatment. Continuous lumbar cistern drainage combined with anti-infection is helpful in thetreatment of patients with severe CSFL associated with intracranial infection.

参考文献/References:

[1] Pham MH, Tuchman A, Platt A, et al. Intracranial complica-tions associated with spinal surgery [J]. Eur Spine J, 2016,25(3): 888-894.
[2] Hawk MW, Kim KD. Review of spinal pseudomeningocelesand cerebrospinal fluid fistulas [J]. Neurosurg Focus, 2000,9(1): e5.
[3] Alvarez CM, Urakov TM, Vanni S. Repair of giant postlami-nectomy pseudomeningocele with fast-resorbing polymermesh: technical report of 2 cases [J]. J Neurosurg Spine,2018, 28(3): 341-344.
[4] ChenS Z, Shimer AL, Nacey NC. Spinal subdural abscessfollowing repeat lumbar microdiscectomy: a case report ofimaging findings for a rare infection [J]. Clin Imaging, 2017,44: 74.
[5] Zhang LM, Ren L, Zhao ZQ, et al. Surgical treatment forbacterial meningitis after spinal surgery: a case report [J].Medicine, 2017, 96(11): e6099.
[6] Endriga DT, Dimar JR, Carreon LY. Communicating hydro-cephalus, a long-term complication of dural tear duringlumbar spine surgery [J]. Eur Spine J, 2016, 25 Suppl 1:157-161.
[7] 王永强，刘晓光，姜亮，等.胸椎管狭窄症术后脑脊液漏继发皮下积液的治疗 [J].北京大学学报（医学版），2018， 50（4）：657-661.
[8] Hu PP, Liu XG, Yu M. Cerebrospinal fluid leakage afterthoracic decompression [J]. Chin Med J (Engl), 2016, 129(16): 1994-2000.
[9] Lee SE, Chung CK, Jahng TA, et al. Dural tear and resultant cerebrospinal fluid leaks after cervical spinal trauma [J].Eur Spine J, 2014, 23(8): 1772-1776.
[10] Wainwright TW, Immins T, Middleton RG. Enhancedrecovery after surgery (ERAS) and its applicability formajor spine surgery [J]. Best Pract Res Clin Anaesthesiol,2016, 30(1): 91-102.
[11]郑亚东，白宇，陆生林，等.负压封闭引流在胸腰椎后路内固定术后早期伤口深部感染治疗中的应用 [J].生物骨科材料与临床研究， 2013，10（1）：35-36.
[12]骆宏伟，李宏斌，曾青东 .胸腰椎骨折患者内固定术后切口深部急性感染的处理 [J].中华医院感染学杂志， 2015， 25（1）：196-198.
[13] Giese H, Meyer J, Unterberg A, et al. Preoperative lumbardrainage placement for surgical cranioplasty [J]. J ClinNeurosci, 2018, 52: 88-91.
[14] Liu B, Wang Y, Zheng T, et al. Effect of intraoperativelumbar drainage on gross total resection and cerebrospinalfluid leak rates in endoscopic transsphenoidal surgery ofpituitary macroadenomas [J]. World Neurosurg, 2020, 135:e629-e639.
[15] Kobayshi K, Ando K, Ito K, et al. Efficacy of intraoperativelumbar subarachnoid drainage for prevention of cerebro-spinal fluid leak after spinal cord tumor resection [J].J Orthop Sci, 2018, 23(2): 266-272.
[16] Fand Y, Shao Y, Lu J, et al. The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoidhemorrhage with different bleeding amounts [J]. NeurosurgRev, 2020, 43(2): 739-747.
[17] Sun T, Guan J, Yang J, et al. Preoperative evaluation usingexternal lumbar drainage for patients with posthemorrhagichydrocephalus: a prospective, monocentric, randomizedcontrolled trial [J]. Medicine, 2020, 99(35): e21872.
[18]中国医师协会神经外科医师分会神经重症专家委员会，北京医学会神经外科学分会神经外科危重症学组 .神经外科中枢神经系统感染诊治中国专家共识（ 2021版） [J].中华神经外科杂志， 2021，37（1）：2-15.

相似文献/References:

[1]裴红莎　刘宝来　聂晓奇　吉宏明　李军伟　郭建忠　邹　鹏　张刚利.磷霉素和头孢哌酮/舒巴坦钠序贯疗法治疗颅内多重耐药鲍曼不动杆菌感染的临床分析[J].中国临床神经外科杂志,2016,(04):232.[doi:10.13798/j.issn.1009-153X.2016.04.013]
[2]陈　俊　周赤忠　付　伟　潘德锐.开颅术后继发性颅内感染致脑梗死15例分析[J].中国临床神经外科杂志,2016,(01):40.[doi:10.13798/j.issn.1009-153X.2016.01.014]
[3]宋越群　于　剑　王莹莹.尿激酶灌洗对脑室出血患者脑室外引流术后颅内感染的影响[J].中国临床神经外科杂志,2016,(10):628.[doi:10.13798/j.issn.1009-153X.2016.10.022]
[4]张洪微,窦榕榕,渠雪红,等.血清降钙素原在开颅术后颅内感染早期诊断中的价值[J].中国临床神经外科杂志,2016,(12):756.[doi:10.13798/j.issn.1009-153X.2016.12.008]
　ZHANG Hong-wei,DOU Rong-rong,QU Xue-hong,et al.The value of serum procalcitonin to early diagnosis of acute bacterial intracranial infection after craniotomy[J].,2016,(02):756.[doi:10.13798/j.issn.1009-153X.2016.12.008]
[5]武元星　郝京京　王　强.血清及脑脊液降钙素原在神经外科术后颅内感染早期诊断中的应用[J].中国临床神经外科杂志,2017,(04):237.[doi:10.13798/j.issn.1009-153X.2017.04.010]
　WU Yuan-xing,HAO Jing-jing,WANG Qiang..Value of procalcitonin in serum and cerebrospinal fluid to diagnosis of intracranial infection early after craniotomy[J].,2017,(02):237.[doi:10.13798/j.issn.1009-153X.2017.04.010]
[6]袁　波　邢海涛　应建有　娄志刚　段勇刚　谭占国.鲍曼不动杆菌致颅内感染的临床特点及救治体会（附7例报道）[J].中国临床神经外科杂志,2017,(04):252.[doi:10.13798/j.issn.1009-153X.2017.04.017]
[7]刘荣华　段奎甲.颅脑术后颅内感染相关危险因素分析[J].中国临床神经外科杂志,2017,(06):407.[doi:10.13798/j.issn.1009-153X.2017.06.014]
　LIU Rong-hua,DUAN Kui-jia..Risk factors related to intracranial infection after craniotomy[J].,2017,(02):407.[doi:10.13798/j.issn.1009-153X.2017.06.014]
[8]乔建华　海　燕.内镜下经蝶入路切除垂体腺瘤术后颅内感染的危险因素分析[J].中国临床神经外科杂志,2017,(06):413.[doi:10.13798/j.issn.1009-153X.2017.06.016]
　QIAO Jian-hua,HAI Yan..Risk factors relate to intracranial infection after endoscope-assisted surgery through endonasal transsphenoidal approach for pituitary adenomas[J].,2017,(02):413.[doi:10.13798/j.issn.1009-153X.2017.06.016]
[9]郭　康　衡立君　孙树凯　张海红　贾　栋.内镜下经蝶术后颅内感染的危险因素分析[J].中国临床神经外科杂志,2017,(06):424.[doi:10.13798/j.issn.1009-153X.2017.06.020]
[10]毋江 杨红利 解旭鹏 王甲光.经鼻蝶入路垂体腺瘤切除术后严重颅内感染合并脑积水2例[J].中国临床神经外科杂志,2017,(10):734.[doi:10.13792017.09/j.issn.1009-153X.2017.10.025]

备注/Memo

备注/Memo:
通讯作者：廖圣芳，E-mail：lsf227771@126.com
更新日期/Last Update: 1900-01-01