神经内镜下经鼻-蝶窦入路术中、术后脑脊液鼻漏的处理  

Management of intraoperative and postoperative cerebrospinal fluid rhinorrhea by neuroendoscopic surgery via endonasal transsphenoidal approach

作　　者：张林[1] 谢宝树[1] 姚文益 高卫真[1] 贾锋[1] 王宇[1] 殷玉华[1] Zhang Lin Xie Baoshu Yao Wenyi Gao Weizhen Jia Feng Wang Yu Yin Yuhua(Department ofNeurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《中国微侵袭神经外科杂志》2016年第9期385-388,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金项目(编号:81471855)

摘　　要：目的探讨神经内镜下经鼻-蝶窦入路术中、术后脑脊液鼻漏的处理策略。方法回顾性分析27例神经内镜下经鼻-蝶窦入路术中、术后发生脑脊液鼻漏病人的临床资料。其中鞍结节脑膜瘤2例,脊索瘤、视神经胶质瘤、上斜坡转移性腺瘤各1例,垂体腺瘤22例。内镜下发现脑脊液鼻漏后,根据漏口大小予以简单修补,或自体脂肪组织、人工硬脑膜及生物蛋白胶等多层材料修补鞍底。术后3~5 d若再漏,予以药物脱水降颅压或持续腰大池引流等处理。结果术中发现小漏口21例,予以简单修补;较大漏口6例,予以分层修补。修补术后再次发生脑脊液鼻漏3例,2例保守治疗,1例持续腰大池引流10 d后治愈。随访5~10个月,未再发生脑脊液鼻漏。结论在神经内镜视野下,术者可及时发现脑脊液漏口,术中多层严密封堵,术后有效对症处理,可明显改善脑脊液鼻漏的预后。Objective To explore the management of intraoperative and postoperative cerebrospinal fluid rhinorrhea（ CFR） by endoscopic surgery via endonasal transsphenoidal approach. Methods Clinical data of 27 patients with intraoperative and postoperative CFR going endoscopic endonasal transsphenoidal surgery were analyzed retrospectively, including 2 with tuberculum sellae meningioma,1 with chordocarcinoma, 1 with optic glioma, 1 with metastatic adenoma of the upper slope and 22 with pituitary adenoma. After finding CFR under endoscope, the patients were dealt with by a simple repair or the sellar floor repair by multilayer materials such as autologous adipose tissue, artificial dura mater, biological protein glue and so on according to the ventage size. If the rhinorrhea reoccurred in 3 to 5d after surgery, the patients were dealt with drug for dehydration and lowering intracranial pressure or continuous lumbar drainage.Results Twenty-one patients with small leakage were dealt with a simple repair in the operation, and 6 patients with bigger leakage were dealt with a multilayer repair. CFR occurred in 3 patients after the operation, and was cured in 2 patients with conservative treatment and in 1 with continuous lumbar drainage for 10 days. During a follow-up period for 5 to 10 months, no patient recurred. Conclusions Surgeon can timely discover CFR under neuroendoscope. The prognosis of CFR can be significantly improved by strict multilayer repair in the operation and effective symptomatic treatment after the operation.

关 键 词：脑脊液鼻漏 神经内镜 手术入路 经鼻-蝶窦 

分 类 号：R651.1[医药卫生—外科学]