内镜脑脊液鼻漏修补术后并发脑脓肿的临床分析  

Clinical analysis of brain abscess after endoscopic repairment of cerebrospinal fluid rhinorrhea

作　　者：李海艳[1] 于焕新[1] 刘钢[1] Li Haiyan;Yu Huanxin;Liu Gang(Department of Otorhinolaryngology Head and Neck Surgery,Tianjin HuanHu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院耳鼻咽喉头颈外科,300350

出　　处：《中华耳鼻咽喉头颈外科杂志》2018年第9期650-654,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨脑脊液鼻漏修补术后并发脑脓肿的临床特点。方法回顾性分析2007年10月至2017年10月，于天津市环湖医院耳鼻咽喉头颈外科行内镜脑脊液鼻漏修补术的149例患者，重点分析术后出现脑脓肿的3例患者的临床特点及治疗方法。结果149例行内镜脑脊液鼻漏修补术的患者中，术后发生额叶脓肿3例，发生率为2.0%，脓肿形成时间为术后10 d内。1例患者抗感染、降颅压等保守治疗治愈，2例患者行脓肿穿刺引流后治愈。随访1～24个月，未见脑脊液鼻漏或脓肿复发。结论内镜脑脊液鼻漏修补术后脑脓肿好发于额叶，术后7～10 d即可形成，治疗首选保守治疗。如症状明显、脓腔融合，可考虑穿刺引流。ObjectiveTo explore the clinical characteristics of the complication of brain abscesses after cerebrospinal fluid rhinorrhea repairment.MethodsA retrospective analysis was conducted on 149 patients undergone endoscopic repairment of cerebrospinal fluid rhinorrhea from October 2007 to October 2017 in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin HuanHu Hospital. The clinical characteristics and treating methods of 3 brain abscess cases were analyzed.ResultsOf the 149 patients accepted the endoscopic repairment of cerebrospinal fluid rhinorrhea, 3 cases were complicated with postoperative brain abscesses, which showed as frontal lobe abscess by strengthened head MRI. The incidence of abscess was 2.0%. Abscess formation time was within 10 d after surgery. One case was treated with antibiotic and reducing intracranial pressure, while other 2 cases were treated with puncture drainage. After following-up of 1 to 24 months, these 3 cases had no recurrence of cerebrospinal fluid rhinorrhea or abscess. ConclusionsThe complication of brain abscess formation after endoscopic repairment of cerebrospinal fluid rhinorrhea is more common in frontal lobe, which may take place within 7-10 d postoperatively. Conservative treatment is the first choice. Under the condition of obvious symptoms and pus cavity fusion, puncture drainage can be performed.

关 键 词：脑脊液鼻漏 脑脓肿 穿刺术 引流术 

分 类 号：R651.1[医药卫生—外科学]