鼻内镜下脑脊液鼻漏修补术

目的 探讨鼻内镜下脑脊液鼻漏修补术的手术方法和治疗效果.方法 回顾性分析1996-2010年诊断为脑脊液鼻漏的54例患者的临床资料,所有患者均行鼻内镜下脑脊液鼻漏修补术.其中,外伤性25例,自发性17例,医源性12例.采用颞肌、颞肌筋膜、中鼻甲黏膜、鼻中隔黏膜、下鼻甲黏膜、阔筋膜、大腿肌肉、腹部脂肪、钩突黏膜、鼻窦黏膜等进行修复.结果 54例患者中,49例一次修补成功,1例2次手术修补成功,1例3次手术修补成功,1例在外院再次手术成功,1例修补不成功,未再治疗,1例术后1年半复发,未再治疗.术后并发症:4例术后出现高热,1例术后出现一过性浅昏迷并高热,1例术后出现癫痫,1例患者术后出现气颅,均经保守治疗痊愈.结论 鼻内镜下脑脊液鼻漏修补术是一种安全、有效和微创的手术方式,手术成功率高,应作为首选治疗方法;准确的漏口定位,选择合适的入路和适宜的修补方法是手术成功的关键.

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea

Objective To present the surgical technique and clinical effect of transnasal endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. Methods From 1996 to 2010,54 patients with CSF rhinorrhea were treated with intranasal endoscopic surgery,including 25 patients with traumatic CSF rhinorrhea,17 patients with spontaneous CSF rhinorrhea,and 12 patients with iatrogenic CSF rhinorrhea.The temporalis muscle,temporalis fascial,middle turbinate mucosa,nasal septum mucosa,inferior turbinate mucosa,fascia lata,leg muscle,abdominal fat,uncinate process mucosa and sinus mucosa were used to repair the fistulae.Results Forty-nine patients were successfully treated after the first operation,1 after the second attempt,1 after the third attempt,and 1 was successfully treated at the second operation in other hospital,1 stopped therapy after an unsuccessful repairing.One patient recurred within one and a half years after operation and stopped therapy.Seven patients developed complications after the operation ( high fever in 4,high fever and transient mild coma in 1,epilepsy in 1,pneumcephalus in 1 ) and were cured afterwards.Conclusions Transnasal endoscopic surgery is safe,effective and microinvasive treatment for patients with CSF rhinorrhea,it is the first choice for repairing of CSF rhinorrhea for its high successful rate.Accurate leakage site identification,selection of suitable approach and repairing method are critical to the success of operation.