鼻内镜下鼻中隔带蒂黏膜瓣修复鼻中隔穿孔和脑脊液鼻漏  

Repair nasal septum perforation and cerebrospinal fluid leak with pediculate mucosal flaps of nasal septum under nasal endoscope

作　　者：李云川[1] 张罗[1,2] 周兵[1] 葛文彤[1] 王先忠[1] 韩德民[1,2] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730 [2]北京市耳鼻咽喉科研究所,北京100005

出　　处：《中国耳鼻咽喉头颈外科》2008年第12期679-681,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨鼻内镜下鼻中隔带蒂黏膜瓣用于修补鼻中隔穿孔和脑脊液鼻漏的疗效。方法2005年8月～2008年2月北京同仁医院鼻科共11例鼻中隔穿孔和8例脑脊液鼻漏患者。鼻中隔穿孔位于鼻中隔前部,穿孔大小0.8 cm～2.0 cm,在鼻内镜下采用邻近穿孔后上方的鼻中隔带蒂黏骨膜瓣(黏软骨膜瓣)向前下反转覆盖于鼻中隔穿孔黏膜缺损处,对侧采用穿孔前下方带蒂黏骨膜瓣(黏软骨膜瓣)和鼻底黏膜瓣或下鼻甲带蒂黏膜瓣覆盖修补穿孔。8例脑脊液鼻漏患者,2例漏出部位在嗅裂,5例漏出部位在筛顶,1例漏出部位位于嗅裂延续至后筛顶,面积大小为0.1 cm×0.8 cm～0.3 cm×0.8 cm。采用邻近的鼻中隔带蒂黏骨膜瓣反转覆盖于缺损处,必要时黏膜瓣中间夹层钩突或中鼻甲骨片,外覆邻近的鼻中隔带蒂黏膜瓣修补漏出部位。结果11例鼻中隔穿孔和8例脑脊液鼻漏均一次修补成功,随访3个月～3年,未见复发。鼻中隔黏膜转瓣后供区黏膜缺损区在2周后基本上皮化。结论鼻中隔带蒂黏骨膜瓣(黏软骨膜瓣)自身有血供,成活率高,获取容易,取材区域广泛,转蒂距离充足,是修补鼻中隔穿孔和嗅裂和筛顶脑脊液鼻漏的良好材料。OBJECTIVE To evaluate the results of repairing nasal septum perforation and cerebrospinal fluid leak with pediculate mucosal flaps of nasal septum under nasal endoscope. METHODS Eleven cases of nasal septum perforations and 8 cases of cerebrospinal fluid leaks were enrolled from August 2005 to February 2008. Nasal septum perforations with the sizes of 0.8cm-2.0cm were repaired with pediculate mucosal flaps of nasal septum, nasal floors or inferior turbinate. Cerebrospinal fluid leaks with the sizes of 0.1cm×0.8cm-0.3cm×0.8cm were repaired with pediculate mucosal flaps of nasal septum. RESULTS All cases of nasal perforations and cerebrospinal leaks were repaired successfully. No recurrence was observed in the follow-up period of 6 months to 3years. CONCLUSION Pediculate mucosal flaps of nasal septum are eligible materials for the repair of nasal septum perforation and cerebrospinal fluid leak under nasal endoscope.

关 键 词：鼻中隔 脑脊液鼻漏 外科皮瓣 修复外科手术 内窥镜检查 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]