经迷路入路听神经瘤切除术后脑脊液漏原因分析及处理策略  

Causal analysis and management strategies of cerebrospinal fluid leakage following translabyrinthine approach for acoustic neuromas

作　　者：张秀菊[1] 申卫东[1] 戴朴[1] 杨伟炎[1] 黄德亮[1] 韩东一[1] 杨仕明[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科 解放军耳鼻咽喉科研究所,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第3期200-204,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：国家973项目（2011CBA01000,2012CB967900）

摘　　要：目的 探讨经迷路入路听神经瘤切除术后脑脊液漏发生的原因和预防、处理措施.方法 回顾性分析解放军总医院耳鼻咽喉头颈外科1983年1月至2013年12月共152例经迷路人路听神经瘤切除术患者术后脑脊液漏的发生情况,并对比采用改良术腔关闭技术前后脑脊液漏发生率的变化.结果 本组病例经迷路、路听神经瘤切除术术后脑脊液漏总的发生率为5.9％ （9/152）,包括4例脑脊液鼻漏、2例脑脊液切口漏、1例脑脊液耳漏、1例脑脊液耳鼻漏、1例鼻漏合并切口漏.采用改良术腔关闭技术前、后脑脊液漏的发生率分别为14.3％（5/35）和3.4％（4/117）,采用改良技术后脑脊液漏发生率明显下降,Fisher精确检验显示其差异具有统计学意义（P＜0.05）.除1例切口漏患者保守治疗后痊愈外,其余病例均经手术探查修补.结论 脑脊液漏是经迷路入路听神经瘤切除术的常见并发症,可能与术腔关闭技术有关,采用改良术腔关闭技术可以明显降低脑脊液漏发生率.Objective The purpose of the report was to investigate the causes of CSF leakage and discuss the methods for prevention and management of CSF leakage following translabyrinthine resection of acoustic neuromas.Methods A retrospective review of cerebrospinal fluid leakage following translabyrinthine approach for 152 acoustic neuromas patients,from January 1983 to December 2013,was performed.The cases were divided into two groups,traditional and modified closure techniques.The incidence of CSF leakage was compared between the two groups.Results The incidence of postoperative CSF leakage by tranlabyrinthine approach was 5.9% （9/152）,with four cases of rhinorrhea,two case of wound leakage,one case of rhinorrhea and otorrhea,one case of otorrhea,and one case of rhinorrhea and wound leakage.The CSF leakage incidence of traditional closure technique was 14.3% （5/35） ; the incidence of modified closure technique was 3.4% （4/117）.After introducing a modified closure technique,the incidence of the CSF leakage significantly decreased.Conclusions As a common complication of translabyrinthine approach,the incidence of CSF leakage is closely related to the closure technique.The incidence of the CSF leakage should decrease dramatically when adopting the modified closure technique.

关 键 词：神经瘤 听 耳外科手术 手术后并发症 脑脊液耳漏 脑脊液鼻漏 

分 类 号：R739.41[医药卫生—肿瘤]