随意黏膜瓣在经鼻内镜修补脑脊液鼻漏手术中的应用  

Application of random pedicle mucosal flap in the treatment of cerebrospinal fluid leak through an endoscopic endonasal approach

作　　者：陈晓栋[1] 石照辉[1] 李晓媛[1] 乔莉[1] 陈福权[1] 

机构地区：[1]第四军医大学附属西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《中国眼耳鼻喉科杂志》2015年第6期416-419,共4页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：陕西省卫生厅卫生科研基金项目(D64);第四军医大学西京医院临床高新技术常规项目(XJGX12C07)

摘　　要：目的利用鼻黏膜血管丰富和带蒂黏膜瓣易于成活的优点，探索随意带蒂黏膜瓣在经鼻内镜颅底缺损修复中的应用方法和可行性。方法2009年6月～2013年8月在我科住院接受经鼻内镜脑脊液鼻漏修补及脑膜脑膨出切除的患者共27例，其中自发性脑脊液鼻漏17例（63．0％）、外伤性脑脊液鼻漏5例（18．5％）、先天性脑脊液鼻漏伴脑膜脑膨出5例（18．5％）。术中根据颅底缺损的部位就近切取带蒂黏膜瓣进行颅底缺损处修补，其中采用蒂在后的小鼻中隔黏膜瓣修复筛板缺损13例（48．2％），采用蒂在前的小鼻中隔黏膜瓣修复筛板缺损9例（33．3％），采用蒂在上的中鼻甲内侧黏膜瓣修复筛顶较大缺损5例（18．5％）。结果术后随访12～60个月（平均37个月），手术成功率为100％，没有出现脑脊液鼻漏复发及其他并发症，供区黏膜缺损区均已上皮化。结论鼻内镜下随意带蒂黏膜瓣取材方便，术中根据颅底缺损大小及位置随意切除适宜大小的带蒂黏膜瓣，是经鼻内镜颅底缺损修复术的良好修复材料。Objective To introduce a method and the feasibility of management of cerebrospinal fluid leak with random pedicle mucosal flap through an endoscopic endonasal approach. Methods The clinical and follow-up data for 27 patients who had undergone endoscopic endonasal reconstruction of meningoencephalocele resection and cerebrospinal fluid rhinorrhea with a random pedicle mucosal flap between June 2009 and August 2013 were reviewed retrospectively . The diagnosis for these patients included 17 spontaneous cerebrospinal fluid rhinorrhea （63. 0% ）, 5 traumatic cerebrospinal fluid rhinorrhea （ 18. 5% ） and 5 congenital cerebrospinal fluid rhinorrhea with meningoencephalocele （ 18.5% ） . Four types of pedicle mucosal flap from nearby were used to repair cranial base defects according to the locations of the defects. Small septum mucosal flap with pedicle in the rear were used in 13 patients （48.2%） with defects in cribriform plate. Small septum mucosal flap with pedicle in the front were used in 9 patients（33.3% ） with defects in cribriform plate. Medium mucosa of middle turbinate with pedicle in the upper were used in 5 patients （ 18.5% ） with bigger defects in ethmoid roof. Results All cases of cerebrospinal leaks were repaired successfully. No recurrence was observed in the follow-up period of 12 to 60 months （average 37 months）. The harvest sit has achieved epithelization. Conclusions Random pedicle mucosal flap from nearby can be harvested and tailed according to the site and size of the skull base defect. Random pedicle mucosal flap are eligible materials for the repair of skull base defects under nasal endoscope.

关 键 词：随意带蒂黏膜瓣 内镜手术 脑脊液鼻漏 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]