脑脊液鼻漏的诊断和治疗

目的总结脑脊液鼻漏的诊断治疗经验。方法分析１９８２～１９９７年３月近１５年内收治的病程３个月以上的２９例脑脊液鼻漏的资料，男１５例，女１４例。成人２５例，儿童４例。病程３个月～２３年。结果自发性脑脊液鼻漏１８例，其中先天畸形３例，空泡蝶鞍８例，肿瘤３例（垂体瘤１例，蝶鞍和嗅裂的化学感受器瘤各１例），未进一步检查自动出院４例；颅脑外伤７例次（１例２次外伤致不同部位脑脊液鼻漏）；医源性（鞍区手术后）脑脊液鼻漏５例。２２例接受了手术修补，脑脊液鼻漏封闭率８１．８％，耳鼻咽喉科修补１６例，封闭率９３．８％。结论脑脊液鼻漏颅外进路经鼻手术修补应是耳鼻咽喉科的专长，特别是近年来开展的经鼻内窥镜下修补。

The diagnosis and treatment of cerebrospinal fluid rhinorrhea

Objective To summarize our experience in managing cerebrospinal fluid(CSF) rhinorrhea. Methods Twenty nine cases with cerebrospinal fluid rhinorrhea from 1982 to March of 1997 were reviewed. The duration of CSF rhinorrhea varied from 3 months to 23 years. The ages of the patients ranged from 7 to 72 years. Results The causes of CSF leak were spontaneous in 18 cases, traumatic in 6 (1 had two accidents and got two different leaking sites) and iatrogenic in 5 cases. Twenty two cases underwent surgical repair. Overall closure rate was 81.8%. The causes,symptoms and signs,sites of leakage and surgical techniques were analyzed. The classification, diagnosis and treatment of CSF rhinorrhea were discussed. Conclusion Transnasal extracranial repair undertaken by otorhinolaryngologists got better closure rate(93.8%)in this group.Transnasal endoscopic repair could afford excellent view, facilitate precise tissue graft placement and get better closure rate.