鼻内镜下鼻腔自体材料即时脑脊液鼻漏修补术(附11例报告)  

Immediate repair of cerebrospinal fluid rhinorrhea with nasal autogenous material under nasal endoscope(a report of 11 cases)

作　　者：蔡菁菁 宋红毛 戴俊 尚静 李峰[3] 徐敏 怀德 程雷 CAI Jingjing;SONG Hongmao;DAI Jun;SHANG Jing;LI Feng;XU Min;HUAI De;CHENG Lei(Department of Otorhinolaryngology,the Affiliated Huai’an Hospital o f Xuzhou Medical University and Huai’an Second Municipal People’s Hospital,Jiangsu,223002,China)

机构地区：[1]徐州医科大学附属淮安医院淮安市第二人民医院耳鼻咽喉头颈外科,江苏223002 [2]徐州医科大学附属淮安医院淮安市第二人民医院影像科 [3]宿迁市泗阳县中医院耳鼻咽喉科 [4]南京医科大学第一附属医院江苏省人民医院耳鼻咽喉科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2020年第4期277-281,共5页Chinese Journal of Otorhinolaryngology in Integrative Medicine

基　　金：江苏省卫健委科研立项面上项目(017012);江苏省淮安市自然科学研究计划(指导性)项目(HABZ201901)。

摘　　要：目的探讨鼻内镜下采用鼻腔自体材料即时脑脊液鼻漏修补术的手术方法和治疗效果及应用价值。方法回顾分析2013年8月至2019年9月在我院住院行鼻内镜手术术中发生脑脊液鼻漏的11例患者临床资料,11例患者初始疾病:鼻息肉伴鼻窦炎3例,鼻腔乳头状瘤1例,鼻腔恶性淋巴瘤2例,鼻腔恶性黑色素瘤2例,鼻颅底肿瘤3例。脑脊液鼻漏病因均为医源性,漏出部位为筛板3例,筛顶5例(含双侧筛顶1例),蝶窦顶壁2例,蝶窦外侧壁1例。脑脊液鼻漏发生后均即时行带蒂鼻中隔或中鼻甲黏膜瓣、钩突黏膜、中鼻甲骨等自体材料修补手术。结果11例患者均一次修补成功,术中及术后均未发生严重并发症。随访6月以上,未见再发脑脊液鼻漏。结论鼻内镜下鼻腔自体材料即行脑脊液鼻漏修补术,具有取材方便及便于固定,带蒂的移植组织血供丰富易存活,相同的组织结构保证腺体的分泌功能,能有效避免鼻腔干燥等不适症状发生等等优点,是一种安全有效和微创的手术方式,值得临床推广应用。Objective To explore the operative method,therapeutic effect and application value of endoscopic repair of cerebrospinal fluid(CSF)rhinorrhea with nasal autogenous material.Methods The clinical data of 11 patients from August 2013 to September 2019,with CSF rhinorrhea during endoscopic surgery in our hospital were analyzed retrospectively.The initial diseases of 11 patients were:3 cases of nasal polyp with sinusitis,1 case of nasal papilloma,2 cases of malignant lymphoma,2 cases of malignant melanoma and 3 cases of tumor at the base of nose and skull.The causes of CSF rhinorrhea were iatrogenic.The leakage site was ethmoidal plate in 3 cases,ethmoidal top in 5 cases(including bilateral ethmoidal top in 1 case),parietal wall of sphenoid sinus in 2 cases and lateral wall of sphenoid sinus in 1 case.After the occurrence of CSF rhinorrhea,the pedicled nasal septum or middle turbinate mucosa flap,uncinate process mucosa,middle turbinate and other autogenous materials were repaired immediately.Results All 11 patients were repaired successfully,and no serious complications occurred during and after the operation.Follow up for more than 6 months showed no recurrence of CSF rhinorrhea.Conclusions Endoscopic repair of cerebrospinal fluid rhinorrhea with nasal autogenous material is a safe,effective and minimally invasive method,which has the advantages of convenient operation,rich blood supply of pedicled transplantation tissue and easy survival.Moreover the same tissue structure could ensure the secretion function of glands,and effectively avoid the occurrence of discomfort symptoms such as nasal dryness.

关 键 词：脑脊液鼻漏 鼻内镜外科 鼻中隔 中鼻甲 修补术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]