颅底重建技术在经鼻内镜手术中的应用  

Application of skull base reconstruction technique in transnasal endoscopic surgery

作　　者：张斌[1] 毕智勇[1] 杨智军 刘丕楠[1] 王博[1] ZHANG Bin;BI Zhi-yong;YANG Zhi-jun(Department of Neurosurgery,Beijing Tiantan Hospital,Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属天坛医院神经外科,北京100070

出　　处：《临床神经外科杂志》2021年第3期291-294,共4页Journal of Clinical Neurosurgery

摘　　要：目的探讨应用颅底重建技术在鼻内镜手术中脑脊液(CSF)漏修补的方法及效果。方法回顾性分析341例经鼻内镜入路手术患者的临床资料。依据患者术中脑脊液漏的分级,采用不同颅底重建方法,明胶海绵、人工硬膜填塞,或自体筋膜、粘膜瓣、脂肪填塞及硬膜缝合进行修补。结果本组患者中92例患者出现术中脑脊液漏,其中69例患者(75%)为Kelly分级2~3级脑脊液漏。术后发生脑脊液漏的患者4例(4.3%),其中1例患者经腰穿引流后治愈,3例患者再次行修补手术治愈。术后随访6~12个月,无患者出现脑脊液漏复发。结论颅底重建技术可明显降低内镜颅底手术后脑脊液漏的发生率,是安全可靠的预防术后出现脑脊液漏的方法。Objective To explore the method and effect of skull base reconstruction in the repair of cerebrospinal fluid(CSF)leakage in endoscopic sinus surgery.Methods The clinical data of 341 patients underwent endoscopic sinus surgery were retrospectively analyzed.According to the classification of CSF leakage,different methods of skull base reconstruction were used,such as gelatin sponge,artificial dural packing,or autologous fascia,mucosal flap,fat packing and dural suture.Results In this group,92 patients had intraoperative CSF leakage,of which 69(75%)were Kelly grade 2-3 CSF leakage.CSF leakage occurred in 4 cases(4.3%),of which 1 was cured after lumbar puncture and drainage,and 3 were cured by repair operation.All patients were followed up for 6-12 months,and no recurrence of CSF leakage occurred.Conclusions Skull base reconstruction technique can significantly reduce the incidence of CSF leakage after endoscopic skull base surgery,which is a safe and reliable method to prevent CSF leakage.

关 键 词：神经内镜 经鼻入路手术 脑脊液漏 颅底重建 

分 类 号：R651[医药卫生—外科学]