外伤性脑脊液鼻漏的手术治疗(附27例分析)

目的探讨外伤性脑脊液鼻漏的手术治疗效果。方法回顾性分析27例行手术治疗的外伤性脑脊液鼻漏病例。术前根据影像学定位行冠状切121开颅入路21例．眉弓切口眶上锁孔入路6例。术前、术后行积极内科治疗。结果21例行开颅手术的病人中19例（90．5％）痊愈，1例症状缓解后经内科治疗痊愈，1例因反复颅内感染而死亡；术后平均住院13．9d。6例行锁孔手术的病人中5例（83．3％）痊愈；1例缓解后经内科治疗痊愈；术后平均住院8．7d。术后随访3个月，均无复发。两种术式在疗效上无明显差别．但术后平均住院时间有显著差异。结论采取冠状切口开颅入路和眉弓切口眶上锁孔入路治疗外伤性脑脊液鼻漏疗效满意。对于漏口位置明确、单侧单一漏口且漏口较小者．眶上锁孔入路能在治愈鼻漏的同时获得更小的手术创伤．住院时间更短。

Surgery for traumatic cerebrospinal rhinorrhea: analysis of 27 cases

Objective To explore the therapeutic effect of surgical intervention for traumatic cerebrospinal rhinorrhea.Methods Twenty-seven cases of traumatic cerebrospinal rhinorrhea treated with surgical intervention were collected and retrospectively analyzed.Twenty-one cases underwent craniotomy via a coronal incision,while the other 6 were treated via supraorbital keyhole approach with an eyebrow incision based on preoperative imaging location.Adequate medical treatment was available during the pre-and post-operative period.Results In the 21 patients who underwent craniotomy,19(90.5%) fully recovered,1 gained relief of symptoms and recovered after medical treatment,and 1 died of recurrent intracranial infection.In those treated via keyhole approach,5 patients(83.3%) fully recovered,and 1 had relief of symptoms and recovered after medical treatment.The average post-operative hospital stay of the patients was 13.9 days in the patients with craniotomy using a coronal incision and 8.7 days in those who were operated on via supraorbital keyhole approach.All the recovered patients(26 cases) were followed up for 3 months without any recurrence.No significant difference in therapeutic effect was found between the two kinds of surgical interventions,but there was a significant deviation in the average post-operative hospital stay.Conclusion Both the craniotomy approach via a coronal incision and the supraorbital keyhole approach via an eyebrow incision can produce satisfactory therapeutic effect for traumatic cerebrospinal rhinorrhea.In patients whose opening of the rhinorrhea is well-located,unilateral,single and small,the supraorbital keyhole approach can reduce surgical trauma and shorten the hospital stay,thus making the patient achieve better recovery.