廖振华 谢仕齐

【摘要】 目的：探究人工硬脑膜贴敷在微血管减压术中的应用及对术后脑脊液漏的影响。方法：本研究为回顾性队列研究，收集2020年1月—2023年4月因三叉神经痛或面肌痉挛在赣南医学院附属兴国医院行经乙状窦后入路微血管减压术的60例患者的资料。根据术中硬脑膜复位方式分成传统组（采用常规硬脑膜原位缝合）和改良组（采用人工硬脑膜贴敷），各30例。比较两组手术有效率，脑脊液漏发生率，以及住院天数、住院费用。结果：两组手术有效率比较，差异无统计学意义（P>0.05）；与传统组比较，改良组脑脊液漏的发生率更低，住院天数更短，住院费用更少（P<0.05）。结论：人工硬脑膜贴敷不会降低手术有效率，且能显著降低微血管减压术后脑脊液漏的发生率。

【关键词】 微血管减压术 脑脊液漏 人工硬脑膜

Application of Artificial Dural Patching in Microvascular Decompression and Its Influence on Postoperative Cerebrospinal Fluid Leakage/LIAO Zhenhua， XIE Shiqi. //Medical Innovation of China， 2024， 21（08）： -137

[Abstract] Objective： To explore the application of artificial dural patching in microvascular decompression and its influence on postoperative cerebrospinal fluid leakage. Method： This study was a retrospective cohort study. Data of 60 patients underwent microvascular decompression via retrosigmoid approach due to trigeminal neuralgia or facial spasm in Xingguo Hospital Affiliated to Gannan Medical College from January 2020 to April 2023 were collected. The patients were divided into the traditional group （was used conventional in-situ dural suture） and the improved group （was used artificial dural patching） according to the intraoperative dural restoration method， with 30 cases in each group. The operative effective rate， incidence of cerebrospinal fluid leakage， hospitalization days and hospitalization expenses were compared between the two groups. Result： There was no significant difference in the operative effective rate between the two groups （P>0.05）. Compared with the traditional group， the incidence of cerebrospinal fluid leakage was lower in the improved group， the hospitalization days was shorter， and the hospitalization expenses was less （P<0.05）. Conclusion： Artificial dural patching does not reduce the operative efficiency， and can significantly reduce the probability of cerebrospinal fluid leakage after microvascular decompression.

[Key words] Microvascular decompression Cerebrospinal fluid leakage Artificial dural

First-author's address： Department of Neurosurgery， Xingguo Hospital of Gannan Medical College， Ganzhou 342400， China

doi：10.3969/j.issn.1674-4985.2024.08.030

顱神经疾病中最多见的为三叉神经痛，其次为面肌痉挛[1]。该类疾病患者在出现疼痛、颜面部痉挛的同时，可能还会出现一些神经症状，严重影响患者的生活[2]。以上疾病多是由微血管压迫所致，目前，微血管减压术是治疗微血管压迫相关疾病的一线治疗方案，具有很高的永久疗效[3-7]。虽然从最初采用的中颅窝入路到现在大部分采用的经乙状窦后入路，为当前的治疗提供了更为理想的手术通道，但脑脊液漏仍是无法完全避免的并发症。该并发症的处理通常是腰椎引流、脑室-腹腔分流术和延长住院时间，然而，即便经过这些治疗，患者也仍然可能出现一些严重的情况，例如假性脑膜膨出、脑膜炎和脓肿形成，甚至会造成永久性损伤[8]。因此，我们在解除微血管压迫后关颅前会常规对硬脑膜进行原位缝合，放回骨瓣，再逐层缝合肌肉，从而防止脑脊液漏。然而……