鼻内镜下应用鼻内自体材料治疗脑脊液鼻漏的临床效果观察

目的 探讨鼻内镜下应用鼻内自体材料治疗脑脊液鼻漏的效果和安全性。方法 回顾性研究。纳入蚌埠医学院第一附属医院耳鼻咽喉头颈外科2014年1月—2017年12月收治的10例脑脊液鼻漏患者,其中男7例、女3例,年龄23~52(41.6±12.5)岁。缺损部位位于筛窦顶壁4例、筛板3例,位于额窦顶、蝶窦顶、额隐窝各1 例。颅底骨质缺损周径小于10 mm者6例、10~20 mm者4 例。通过详细的术前检查初步判断颅底缺损部位,按照不同部位颅底缺损的大小及脑脊液鼻漏的严重程度,采用鼻内镜下不同的鼻内自体材料重建鼻颅底缺损,其中6例应用自体鼻中隔黏软骨膜-软骨瓣,4例应用自体中鼻甲黏膜瓣。术后定期行神经系统检查,脑脊液生化检查糖定量,随访观察有无复发。结果 本组10例患者手术时间1~2.5 h,术中出血20~50 mL,住院时间7~14 d。术后患者生命体征平稳,神经系统病理征均阴性,脑脊液生化检查糖定量均低于1.7 mmol/L,术前头痛症状消失。出院前鼻内镜检查术区,无一例修补材料坏死、脱落。出院后6 个月随访,均无脑脊液鼻漏复发。结论 鼻内镜下利用鼻内自体材料重建鼻颅底缺损治疗脑脊液鼻漏安全、可行,术中取材方便、创伤小、手术成功率高、术后复发率低,值得临床推广应用。

Clinical observation of endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue

Objective To explore the effect and safety of endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue.Methods Ten cases of traumatic cerebrospinal fluid rhinorrhea patients with endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue was retrospectively analyzed. There were 7 males and 3 females, aged 23-52 (average 41.6±12.5) years old. The defect site was located in the anterior wall of the ethmoid sinus (4 cases), the sieve plate( 3 cases),the frontal sinus apex(1 case), sphenoid sinus(1 case), and frontal crypt(1 case). There were 6 patients with a skull base defect less than 10 mm and 4 patients with 10-20 mm.According to the size of skull base defect and the degree of cerebrospinal fluid rhinorrhea , nasal endoscopic reconstruction of nasal skull base defect with intranasal autologous tissue was performed. Six cases were resection and repaired with button-typed nasoseptal mucosal-cartilage flap. Four cases were resection and repaired with concha nasalis media flap. Neurologic examination and cerebrospinal fluid biochemical examination were performed after operation. To observe the recurrence of cerebrospinal fluid.Results The operation time of 10 patients was 1-2.5 h, with the 20-50 mL intraoperative bleeding loss, and the hospital stay was 7-14 d. After operation, the patient's vital signs were stable, the pathological signs of the nervous system were negative, and the cerebrospinal fluid biochemical examination was less than 1.7 mmol/L.The headache symptoms before the operation disappeared. Before the discharge, there were no repair material necrosis or shedding in the endoscopic examination area. There was no recurrence of cerebrospinal fluid rhinorrhea after 6 months of follow-up after discharge.Conclusions It's safe and feasible to reconstruct the defect of nasal skull base with autogenous tissue under nasal endoscope for the treatment of cerebrospinal fluid rhinorrhea.This surgery has several advantages of convenience for taking tissue, less trauma, high success rate and low recurrence rate. It is worthy of clinical application .