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| 題 名 | Closed Subarachnoid Drainage for Management of Cerebrospinal Fluid Leakage after Lumbar Spinal Operations=使用閉鎖式蜘蛛膜下引流治療腰椎手術後併發腦脊髓液漏出症之經驗 |
|---|---|
| 作 者 | 王德源; 陳孟意; 陳賢德; 王俊能; 吳國暉; 劉世成; 林茂仁; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 29:6 民85.11-12 |
| 頁 次 | 頁479-484 |
| 分類號 | 416.61 |
| 關鍵詞 | 閉鎖式蜘蛛膜下引流; 腰椎手術; 腦脊髓液漏出症; Cerebrospinal fluid; Leakage; Closed subarachnoid drainage; |
| 語 文 | 英文(English) |
| 中文摘要 | 從1990年一月至1994牢三月,本院骨科部使用閉鎖式蜿蛛膜下引流治療 10個病患因腰椎手術後腦脊髓液漏出之併發症。此方法為在腰惟處以麻醉科使用 之硬膜外裝置,以同樣之手法將導管曲皮下穿入至蚵蛛膜下,再將導管前端置於 第I2胸椎及第一腰椎間之齣蛛膜下。此導管之外側端則接至無菌之空點滴瓶或是 血液收集袋,以構成一個閉鎖式引流裝置。此裝置至少放置4天以後才取掉。在 所有I0個病例中,有一名病人在使用此引流管第三天因其他原因而死亡,其餘9 個病例使用此種方法後其腦脊髓液漏出症皆癒合。在治療過程中有三個病人有頭 痛、噁心、嘔吐之現象,另有一病人有出汗現象。但皆可經由靜脈點滴補充體液 後得以緩解。有二個病人在使用此方法後併發細菌感染,但經使用抗生素治療並 繼續導管引流,此感染及腦脊髓液漏出症皆得以痊癒。另有四個病人除了有腦脊 髓液漏出外,同時併有細菌感染,經由蜘蛛膜下引流治療後,此腦脊髓液漏出症 及細菌感染皆治癒。 使用此種閉鎖式蜘蛛膜下引流治療腰椎手術後併發腦脊髓液漏出症之結果,顯示 此種治療如在小心控制及操作下,是一種簡單有效的非開刀式之方法。 |
| 英文摘要 | Between 1990 and 1994, we treated 10 cases of CSF leakage after lumbarspinal operation by closed subarachnoid drainage. The method used for thedrainage was a closed catheter system. The shunt was percutaneouslyinserted into the subarachnoid space in the lumbar region by using a standard epidural set, and advancing the cephalad to the level of T12/L1 interspace. Then the drainage system was connected to a hemovac bag or sterilized IV bottle. It was removed after four or more days. All 10 patientswere available for follow-up except for a patient who died from an unrelated cause the third day after insertion of the drainage catheter. Theremaining nine patients had resolution of the leakage of cerebrospinalfluid from the wound. During subarachnoid drainage, three patients hadtransient complaints of headache, nausea and vomiting. One patient haddiaphoresis. All were relieved by IV fluid supply. Two patients had evidenceof an intradural infection after placement of the catheter, but infection wasresolved in both after removal of the catheter and treatment with appropriate antibiotics. There were four cases with infected CSF leakage.Both the infection and the leakage healed after treatment with closedsubarachnoid drainage. The results showed that closed subarachnoiddrainage, when properly performed and monitored, is a simple and effectivenon-operative method for treating dural-cutaneous CSF leaks after lumbarspinal operation. |
本系統中英文摘要資訊取自各篇刊載內容。