氰基丙烯酸酯医用胶预防脑脊液漏的疗效观察_《中国修复重建外科杂志》

作者：

于淼 ¹ , 江晓兵 ² , 姚珍松 ² , 庄洪 ² , 梁德 ² , 丁金勇 ² , 张顺聪 ² , 唐永超 ² , 邢润麟 ¹

1广州中医药大学（广州，510405）;;
2广州中医药大学第一附属医院二骨科;

关键词：

脑脊液漏氰基丙烯酸酯医用胶硬脊膜下肿瘤水密修补

DOI：

10.7507/1002-1892.20130323

视频：

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目的探讨脊柱硬脊膜下良性肿瘤切除后采用氰基丙烯酸酯医用胶（商品名：福爱乐医用胶）修补硬脊膜预防脑脊液漏的应用价值。方法2009年1月－2013年3月，对19例患者行后路硬脊膜下肿物切除后采用福爱乐医用胶联合明胶海绵修补硬脊膜（试验组），与同期16例仅采用明胶海绵修补的患者（对照组）进行比较。两组患者性别、年龄、病程、肿瘤类型、肿瘤节段等一般资料比较，差异均无统计学意义（P gt; 0.05），具有可比性。对比分析两组硬脊膜水密修补成功率、切口愈合情况及其相关并发症。结果两组患者术中检查均达到水密修补。两组手术时间、术中出血量、硬脊膜切口长度、住院时间、总引流量及引流时间比较，差异均无统计学意义（P gt; 0.05）。术后切口均Ⅰ期愈合，无延迟愈合、感染等相关并发症发生，无神经压迫症状出现。末次随访时，试验组17例保持水密修补，2例出现术后脑脊液漏，修补成功率89.5%；对照组8例保持水密修补，8例出现术后脑脊液漏，修补成功率50.0%；两组修补成功率比较差异有统计学意义（P=0.02）。术后1、3个月随访时患者均未发生迟发脑脊液漏及切口感染。结论脊柱硬脊膜下良性肿瘤切除后使用氰基丙烯酸酯医用胶修补硬脊膜是一种安全、有效方法。

引用本文： 于淼,江晓兵,姚珍松,庄洪,梁德,丁金勇,张顺聪,唐永超,邢润麟. 氰基丙烯酸酯医用胶预防脑脊液漏的疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1471-1474. doi: 10.7507/1002-1892.20130323 复制

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12.	Chauvet D, Tran V, Mutlu G, et al. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien), 2011, 153(12): 2465-2472.
13.	Narotam PK, Jose S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2869.
14.	Kaufman BA, Matthews AE, Zwienenberg-Lee M, et al. Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery. J Neurosurg Pediatr, 2010, 6(4): 359-363.
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17.	Feinberg EB, Funderburk R. Infectious disease risks of fibrin glue. Ophthalmic Surg, 1993, 24(3): 206.
18.	李伯清, 杨仲春. 2-氰基丙烯酸酯的制法及用途. 化工技术与开发, 2007, 36(3): 30-32.
19.	Ozisik PA, Inci S, Soylemezoglu F, et al. Comparative dural closure techniques: a safety study in rats. Surg Neurol, 2006, 65(1): 42-47.
20.	de Almeida Manzano RP, Naufal SC, Hida RY, et al. Antibacterial analysis in vitro of ethyl-cyanoacrylate against ocular pathogens. Cornea, 2006, 25(3): 350-351.
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22.	Kitoh A, Arima Y, Nishigori C, et al. Tissue adhesive and postoperative allergic meningitis. Lancet, 2002, 359(9318): 1668-1670.
23.	Cohen-Gadol AA, Bellew MP, Akard W, et al. The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery. Mini Invasive Neurosurg, 2010, 53(4): 207-209.

1. Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976), 2006, 31(22): 2609-2613.
2. Hirano K, Imagama S, Sato K, et al. Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study. Eur Spine J, 2012, 21(10): 2019-2026.
3. Grimm S, Chamberlain MC. Adult primary spinal cord tumors. Expert Rev Neurother, 2009, 9(10): 1487-1495.
4. Conti P, Pansini G, Mouchaty H, et al. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol, 2004, 61(1): 34-44.
5. Iacoangeli M, Gladi M, Di Rienzo A, et al. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature. Clin Interv Aging, 2012, 7: 557-564.
6. Beall DP, Googe DJ, Emery RL, et al. Extramedullary intradural spinal tumors: a pictorial review. Curr Probl Diagn Radiol, 2007, 36(5): 185-198.
7. Thomas A, Shetty AP, Rajasekaran S. Abducens nerve palsy associated with pseudomeningocele after lumbar disc surgery: a case report. Spine (Phila Pa 1976), 2012, 37(8): E511-513.
8. 程增银, 马文海, 崔建平, 等. 延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察. 中国脊柱脊髓杂志, 2010, (12): 985-987.
9. Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg (Am), 1998, 80(12): 1728-1732.
10. Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res, 2001, (389): 238-247.
11. Kim KD, Wright NM. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in thespine: results of a prospective, multicenter, randomized controlled study. Spine (Phila Pa 1976), 2011, 36(23): 1906-1912.
12. Chauvet D, Tran V, Mutlu G, et al. Study of dural suture watertightness: an in vitro comparison of different sealants. Acta Neurochir (Wien), 2011, 153(12): 2465-2472.
13. Narotam PK, Jose S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2869.
14. Kaufman BA, Matthews AE, Zwienenberg-Lee M, et al. Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery. J Neurosurg Pediatr, 2010, 6(4): 359-363.
15. Epstein NE. Dural repair with four spinal sealants: focused review of the manufacturers’ inserts and the current literature. Spine J, 2010, 10(12): 1065-1068.
16. Jankowitz BT, Atteberry DS, Gerszten PC, et al. Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J, 2009, 18(8): 1169-1174.
17. Feinberg EB, Funderburk R. Infectious disease risks of fibrin glue. Ophthalmic Surg, 1993, 24(3): 206.
18. 李伯清, 杨仲春. 2-氰基丙烯酸酯的制法及用途. 化工技术与开发, 2007, 36(3): 30-32.
19. Ozisik PA, Inci S, Soylemezoglu F, et al. Comparative dural closure techniques: a safety study in rats. Surg Neurol, 2006, 65(1): 42-47.
20. de Almeida Manzano RP, Naufal SC, Hida RY, et al. Antibacterial analysis in vitro of ethyl-cyanoacrylate against ocular pathogens. Cornea, 2006, 25(3): 350-351.
21. Leggat PA, Smith DR, Kedjarune U. Surgical applications of cyanoacrylate adhesives: a review of toxicity. ANZ J Surg, 2007, 77(4): 209-213.
22. Kitoh A, Arima Y, Nishigori C, et al. Tissue adhesive and postoperative allergic meningitis. Lancet, 2002, 359(9318): 1668-1670.
23. Cohen-Gadol AA, Bellew MP, Akard W, et al. The application of n-butyl 2-cyanoacrylate to repair CSF fistulas for 221 patients who underwent transsphenoidal surgery. Mini Invasive Neurosurg, 2010, 53(4): 207-209.

《中国修复重建外科杂志》

氰基丙烯酸酯医用胶预防脑脊液漏的疗效观察

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《中国修复重建外科杂志》

氰基丙烯酸酯医用胶预防脑脊液漏的疗效观察

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