37例帽状腱膜下层-骨膜复合瓣翻转修补脑脊液鼻漏疗效分析  

Pedicled pericranial flap repaires cerebrospinal fluid rhinorrhea :A clinical efficacy analysis of 37 cases

作　　者：王博[1] 杨智君[1] 李智[1] 周强意 王兴朝[1] 王振民[1] 李朋[1] 刘丕楠[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100050

出　　处：《中国现代医生》2016年第7期62-65,共4页China Modern Doctor

基　　金：国家科技支撑计划项目(2012BAI12B03);国家自然科学基金资助项目(81372715);北京天坛医院青年基金(2015-YQN-10)

摘　　要：目的探讨帽状腱膜下层-骨膜复合瓣翻转修补脑脊液鼻漏的疗效及技术要点。方法回顾性分析2003年9月～2014年9月我院应用帽状腱膜下层-骨膜复合瓣翻转修补37例脑脊液鼻漏患者的临床资料。结果在37例患者中术中发现多发漏口为29例,单一漏口8例,单一漏口直径均〉1.5 cm。本组患者均经1次手术修补成功,6例患者术后出现额部麻木,5例患者出现术后额纹消失,9例患者出现术后颅内感染,应用抗生素及间断腰穿后痊愈,1例患者术后半年从事重体力劳动致脑脊液鼻漏复发,再次开颅行修补后因术后特发性颅高压致大面积脑梗死死亡,随访3～144个月,平均随访52.4个月,均未复发。结论采用帽状腱膜下层-骨膜复合瓣翻转修补脑脊液鼻漏具有安全可靠、操作简单、取材方便的优点,对于多发或复杂前颅底漏口的治疗具有优势。Objective To investigate the microsurgery technique and clinical value of repairing cerebrospinal fluid rhinorrhea with pedicled pericranial f1 ap. Methods Clinical data of 37 cases of cerebrospinal fluid rhinorrhea repaired with pedicled pericranial f1 ap in our hospital from September 2003 to September 2014 were analyzed retrospective ly.Results Among 37 patients,multipleleak openings were detected in 29 patients, and single leak opening（diameter greater than 1.5 cm） were confirmed in the other 8 patients. All the patients got the repairments successfully. Postoperatively, 6 patients felt forehead numbness, and 5 patients＇ frontal wrinklese were disappeared. 9 patients had intracranial infection, however, they recovered fully byantibiotic therapy and intermittent lumbar puncture. Only 1 patient had recurrence because of heavy physical labour, and the patient had been re-operated and died from large cerebral infarction due to cerebral perfusion pressure. The other patients showed no recurrence during a follow-up period between 3months to 144 months（mean 52.4 months）. Conclusion Repairing cerebrospinal fluid rhinorrhea with pedicled pericranial f1 ap is safe and convenient, and it is especially with obvious advantage for repairing the multiple and complex leakage sites.

关 键 词：脑脊液鼻漏 帽状腱膜下层-骨膜复合瓣 颅底重建 显微外科手术 

分 类 号：R651.1[医药卫生—外科学]