经鼻内镜外伤性脑脊液鼻漏修补术

目的总结鼻内镜下外伤性脑脊液鼻漏修补术的经验。方法分析1991年9月-2002年12月采用鼻内镜下修补外伤性脑脊液鼻漏患者49例资料。介绍了修补术的方法，并就脑脊液鼻漏的诊断，手术适应证、手术时机及手术中的关键问题等进行了讨论。结果内镜下外伤性脑脊液鼻漏修补术一次成功治愈占95．9％(47／49)。失败的1例经第2次鼻内镜手术后治愈。最后的鼻内镜手术治愈率为98．0％；其中1例为额窦后壁创伤内镜下手术失败后改为鼻外进路修补成功。有1例伴有外伤性梗阻性脑积水患者，术后出现颅高压的并发症，抢救成功。结论鼻内镜下修补术是外伤性脑脊液鼻漏的首选外科治疗方法。

Repairing of traumatical cerebrospinal rhinorrhea by intranasal endoscopic approach

To summarize our experience in managing traumatical cerebrospinal fluid rhinorrhea with intranasal endoscope. 49 cases of traumatical cerebrospinal fluid rhinorrhea treated with surgery of intranasal endoscopy between September of 1991and December of 2002 were reviewed. The steps and methods of the operation were introduced. It also was discussed about the diagnose, the indication, the time and the skill of the operation. Endoscopic repairing of traumtical cerebrospinal rhinorrhea was successful in 95.9 %(47/49) after first operation. One persistent leaks was closed after a second endoscpical operation. Ultmately, 98.0% of leaks were repaired by the operational approach. One case with frontal posterior wall trauma accepted a failed endoscopic surgery, but it was repaired successfully by external nasal surgery. Another case associated with traumatic obstructive hydrocephalus that had a complication of intracranial hypertension after operation was saved successfully. Conclusions] Transnasal endoscopical approach is the best surgical method for treating traumatical cerebrospinal rhinorrhea.