荧光素钠鼻腔局部使用在内镜经鼻脑脊液鼻漏修补术中的应用  

Application of topical intranasal fluorescein in endoscopic endonasal repair of cerebrospinal fluid leakage

作　　者：刘海生[1] 梁晖[1] 王东[1] 王岩[1] 郑佳平[1] 王云鹏[1] 陈业涛[1] 王世杰[1] 陈国强[1] 左焕琮[1] 

机构地区：[1]清华大学玉泉医院神经外科,100049

出　　处：《中华医学杂志》2009年第1期63-65,共3页National Medical Journal of China

基　　金：基金项目：清华-裕元医学基金资助项目（20240000559）

摘　　要：目的探讨荧光素钠鼻腔局部使用在脑脊液鼻漏术前定性诊断及内镜经鼻修补术中漏口定位诊断中的作用。方法15例内镜经鼻手术治疗的脑脊液鼻漏病人，术前及术中将5％荧光素钠棉片放置在中鼻道、筛顶、蝶筛隐窝及术中可疑漏口部位，以棉片颜色由黄褐色变为绿色为脑脊液漏判断标准，与糖定量检查、术中所见及术后随访结果判断诊断的准确率。结果15例脑脊液鼻漏病人，其中10例为自发性脑脊液鼻漏、5例为外伤性脑脊液鼻漏。术前定性诊断率及术中定位准确率为100％。随访2～24个月，脑脊液鼻漏无复发，无并发症发生。结论荧光素钠在鼻腔局部使用是脑脊液鼻漏术前定性诊断及内镜经鼻修补术中漏口定位诊断的一种无创、简便、可靠的方法，可以作为鞘内荧光素钠一种替代的诊断及定位脑脊液鼻漏的方法。Objective To investigate the effects of topical fluorescein on the preoperative diagnosis of rhinorrhea of cerebrospinal fluid （CSF） and intraoperative localization of CSF fistula. Methods Cotton pads soaked with 5% fluorescein were placed in the middle turbinate meatus, roof of ethmoid plate, and sphenoethmoidalis recesses via endoscopic endonasal technique of 15 patients with CSF rhinorrbea, 5 caused by accidental trauma and 10 spontaneous. Change of the color of fluorescein from yellow to green fluorescence denoted the presence of CSF, and thus the site of the leak could be traced. The accuracy rates of diagnosis and leak site identification by this technique were compared with those by glucose analysis, intraoperative findings, and follow-up. Results The preoperative diagnosis rate of CSF rhinorrhea and the CSF fistula site localization rate by fluorescein-soaked cotton pad were both 100%. No recurrence was found during the follow-up for 2 -24 months. No complication had been reported. Conclusions Application of topical flaorescein is an easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas and should be considered a viable noninvasive alternative to intrathecal fluorescein technique.

关 键 词：荧光素 脑脊液鼻漏 内窥镜 

分 类 号：R686[医药卫生—骨科学]