外伤性脑脊液鼻漏58例回顾分析

目的总结外伤性脑脊液鼻漏治疗的临床经验。方法回顾性分析1993年1月至2003年12月收治58侧外伤性脑脊液鼻漏的手术方式、术后并发症及随访结果。结果随访6个月至9年，平均5年。28例保守治疗全部治愈。8例开颅手术、2例鼻外入路和3例显微镜下鼻内入路均治愈。17例内镜下修补术者1次手术治愈15例，2次手术治愈1例，3次手术治愈1例。最终成功率100％。结论对于外伤性脑脊液鼻漏者，应根据病情需要、医院条件和手术医师经验来适当选择适当的手术时机和手术方法。损伤小、疗效好是治疗外伤性脑脊液鼻漏的发展方向。

Management for traumatic cerebrospinal rhinorrhea

Objective To summarize the clinical experience in managing traumatic cerebrospinal rhinorrhea.To ascertain the effective way of management for traumatic cerebrospinal rhinorrhea.Methods 58 cases of traumatic cerebrospinal rhinorrhea between 1991 and 2003 were investigated for:the conservative time,causes,complications,leaksites,repairing materials and surgical methods.28 cases were treated with conservative therapy,8 cases with transcranial repair,2 cases with extranasal repair,3 with tranasal repair under microscope,and 17 cases with transnasal endscopic management.Results The follow-up time ranged from 6 months to 9 years,with a mean duration of 5 years.28 cases had no cerebrospinal rhinorrhea after conservative treatment with an average 16 days.Endscopic repair of cerebrospinal rhinorrhea was successful in 88.23%(15/17) cases after the first attempt,one persistent leaks was closed after the second attempt,the other persistent leaks was also closed after the third attempt.Ultimately 100%(17/17) of the leaks were repaired using an endscopic approach.The traumatic cerebrospinal rhinorrhea repaired with other surgical methods were all successful.Conclusions Management for traumatic cerebrospinal rhinorrhea can be chosen based on different conditions.Minimized damage and better efficacy are the future methods.