脑脊液鼻漏的治疗

目的 总结脑脊液鼻漏治疗的临床经验，评价不同的治疗方法，提出脑脊液鼻漏外科治疗的术式。方法 回顾分析1991年3月－2001年11月83例脑脊液鼻漏，共有5种治疗形式，保守治疗17例，开颅手术修补8例，鼻外入路修补术2例，显微镜下鼻内入路修补术3例，鼻内镜下修补术54例。分析保守治疗的时间及外科治疗各组病例的病因，伴发病，漏口部位及修补材料等。讨论手术时机，手术适应证和术中的关键问题。结果 随访6个月－9年。17例保守治疗全中治愈，平均治愈时间16d。开颅手术8例，鼻外入路的2例和显微镜下鼻内入路的3例均治愈。54例鼻内镜下修补术者1次手术治愈49例（90．1％）；2次手术治愈2例（2／4），3次手术治愈1例，4次手术治愈1例，最终成功率98％，1例额窦漏口者第一次手术失败后改为鼻外入路修补成功。结论 鼻内镜下脑脊液鼻漏修补术是外科治疗脑脊液鼻漏的首选术式，其他术式可依病情需要适当选择。外伤性或手术并发的脑脊液鼻漏保守治疗的时间一般为2－4周，个别病例可达6－8周。

Surgical management of cerebrospinal fluid rhinorrhea]

OBJECTIVE: To summarize the clinical experience in managing cerebrospinal fluid (CSF) rhinorrhea. To ascertain the best effective surgical management for CSF rhinorrhea. METHODS: A retrospective study of 83 patients with CSF rhinorrhea from March 1991 to August 2001 was conducted. Among them, 17 patients were treated with conservative therapy, 8 with transcranial repair, 2 with extranasal repair, 3 with transnasal repair under microscope and 54 with transnasal endoscopic management. The conservative time, causes, complications, leak sites, repairing materials and surgical methods were analysed. RESULTS: All patients were followed -up for 6 months to 9 years. 17 cases had no CSF rhinorrhea after conservative treatment with an average time 16 days. Endoscopic repair of CSF leaks was successful in 90% (49/54) of the cases after a first attempt. Two persistent leaks (2/4) were closed after a second attempt. The other persistent leaks were also closed, one case after third and one after fourth attempt. Ultimately 98% (53/54) of the leaks were repaired using an endoscopic approach. Only one failed after transendoscopic management, and succeeded with a second extranasal repair. The CSF rhinorrhea repaired with other surgical methods were all successful. CONCLUSION: Transnasal endoscopic management is the best method for repairing CSF rhinorrhea, other surgical methods can be chosen based on different conditions. The conservative time are 2 to 4 weeks if a CSF leak is caused by trauma or operation, 6 to 8 weeks conservative time for special cases.