急性外伤性脑脊液鼻漏、耳漏合并颅内血肿的手术治疗  

Surgical Treatment of Acute Traumatic Cerebrospinal Fluid Rhinorrhea or Otorrhea Concurrent with Intracranial Hematoma

作　　者：李敏洪[1] 蒋宇钢[1] 张凌云[1] 王京[1] 

机构地区：[1]中南大学湘雅二医院神经外科

出　　处：《中国现代手术学杂志》2004年第5期276-278,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的　总结颅底骨折所致急性脑脊液鼻漏、耳漏合并颅内血肿的手术治疗效果。　方法对 37例患者进行手术治疗 ,在清除颅内血肿的同时行硬脑膜修补 ,骨蜡、肌肉组织填塞颅底骨折缝隙、额窦、乳突气房 ,硬脑膜漏口及颅底骨折均用EC耳脑胶粘合以加固修补。　结果　术后 33例脑脊液漏一次性治愈 ;1例鼻漏患者术后 15d漏液 ,经再次修补治愈 ;1例颅内感染 (脑膜炎 ) ,经腰穿鞘内注射噻吗灵治愈 ;2例直接死于颅脑损伤。　结论　急性外伤性脑脊液鼻漏、耳漏合并颅内血肿有手术指征者 ,血肿清除后应在硬脑膜水平进行漏口修补 ,同时将颅底骨折缝隙、破裂的额窦、乳突、筛板严密封闭 ,可有效预防术后颅内感染。Objective To summarize the experience of acu te traumatic cerebrospinal fluid rhinorrhea or otorrhea concurrent with intracrani al hematoma due to basal fracture. Methods 37 patients u nderwent operation, intracranial hematoma was removed while crevice of basal fra cture, frontal sinus and mastoid air cells were filled with wax and muscular tis sue, dural ventage and basal fracture were repaired with EC glue. Re sults 33 patients were cured after the first repair. Rhinorrhea recu rred 15 days after operation in one patient, which stopped after another repair. Complication of intracranial infection (cerebromeningitis) occurred in one pati ent which was cured by intrathecal injection. 2 patients died of severe brain in jury. Conclusion The patients with operative indi cations of acute traumatic cerebrospinal fluid rhinorrhea and/or otorrhea, concurrent w ith intracranial hematoma should get the ventage repaired in the dural level aft er the hematoma removed. The crevice of basal fracture, frontal sinus, mastoid a ir cells should be exactly closed to prevent post-operation infection.

关 键 词：颅内血肿 脑脊液鼻漏 颅底骨折 急性外伤 硬脑膜 治愈 手术治疗 术后 额窦 颅内感染 

分 类 号：R651.15[医药卫生—外科学]