脑脊液鼻漏的外科治疗(附12例分析)

目的:探讨损伤性脑脊液鼻漏的诊断和治疗。方法:回顾分析1985年至2001年收治的12例损伤性脑脊液鼻漏的临床资料。结果:男7例、女5例,平均26.3岁,左侧5例、右侧7例;外伤10例(占83.33%),其中工伤和交通伤7例(58.33%),医源性损伤3例(25%,均发生于鼻息肉手术和鼻内筛窦开放术后);先天性脑膜脑膨出2例(16.67%)。病程3个月~22年,合并化脓性脑膜炎5例。症状为鼻腔流清水样液体,并经糖定量检查、影像及鼻内镜检查确诊;所有病例保守治疗2~3周无效再行手术修补。手术径路有鼻侧切开4例、面中部翻揭径路5例、鼻内镜2例、鼻侧切开+鼻内窥镜1例。一次手术治愈10例(83.33%),二次手术治愈1例,四次手术治愈1例。随访0.5~10年,远期均未出现脑脊液鼻漏复发。无颅内感染癫痫等术后并发症。结论:急性损伤性脑脊液鼻漏经及时保守治疗,大部分患者能自愈;无效者均须手术修补,手术成功的关键在于瘘孔的定位、术式和修补材料的正确选择以及贯穿始终的保守治疗措施。因鼻内镜手术视野广、亮度大、配套器械齐全、视频实时监控及创伤小等优点,应作为瘘孔定位及治疗的首选。

Surgical treatment of cerebrospinal fluid rhinorrhea: A report of 12 cases

Objective: To study the diagnosis and treatment of traumatic cerebrospinal fluid rhinorrhea.Method:Data of 12 cases of traumatic cerebrospinal fluid rhinorrhea treated between 1985 and 2001 were retrospectively analyzed.Results: Among the twelve cases(7 males,5 females;26.25 years old on average;5 left,7 right), ten(83.33%) presented with traumatic cerebrospinal fluid rhinorrhea,of whom seven(58.33%) were caused by industrial or traffic accident injury and the other three(25.00%) by iatrogenic trauma.The other two cases had congenital meningoencephalocele.The course of the disease ranged from 3 to 22 months.Five cases were with the complication of purulent meningitis.Besides the clinical symptom of watery rhinorrhea,glucose quantitative examination,and image and nasal endoscopy were performed to identify the diagnosis.All the twelve cases accepted surgical repair because of failure conservative treatment for 2 to 3 weeks.Surgical approach can be divided into :(1)lateral rhinotomy for four cases,(2)midfacial degloving operation for five cases,(3)transnasal endoscopy for two cases and(4)combined lateral rhinotomy with transnasal endoscopy for one case.In ten patients(83.33%) out of the twelve,the fistula was successfully repaired by a single operation,one patient required a re-operation and another one underwent surgery for four times.All the patients were followed up for six months to ten years.None of the patients had any severe complications,such as recurrence,intracranial infection,epilepsy and so on.Conclusions: Most of the acute traumatic cerebrospinal fluid rhinorrhea can spontaneously disappear after prompt conservative treatment.Surgical repair is needed if the conservative treatment is failure.A successful surgery depends on accurate fistula location,correct selection of surgical approach and repair material and persistent conservative treatment.Endoscopy should be regarded as the technique of choice with the virtue of wide field of view,high brightness,complete line of related instruments,real-time video monitoring and minor trauma.