自发性脑脊液鼻漏瘘口定位与内镜手术21例分析  

FISTULA LOCALIZATION AND ENDOSCOPIC SURGERY FOR SPONTANEOUS CEREBROSPINAL FLUID RHINORRHEA:AN ANALYSIS OF 21 CASES

作　　者：曹志刚 杨凤玉 张进武 程德奎 李子吉 刘伟[1] CAO Zhigang;YANG Fengyu;ZHANG Jinwu;CHENG Dekui;LI Ziji;LIU Wei(Department of Neurosurgery,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院神经外科,山东青岛266003 [2]青岛市城阳区人民医院神经外科

出　　处：《青岛大学学报（医学版）》2021年第3期427-431,共5页Journal of Qingdao University(Medical Sciences)

基　　金：山东省医药卫生科技发展计划项目(2013WS0012)。

摘　　要：目的探讨自发性脑脊液鼻漏的瘘口定位诊断方法及内镜手术治疗策略。方法回顾性分析21例自发性脑脊液鼻漏病人的临床资料。21例病人均术前应用CT及MRI检查确定瘘口位置,采用经鼻入路神经内镜手术修补脑脊液鼻漏。结果应用不同体位的CT及MRI T_2加权像检查,术前20例成功定位瘘口位置,经手术验证位置准确。术后随访3个月~3年,19例治愈,2例复发,复发病例经二次手术后治愈,无手术并发症。结论不同体位的颅底CT和颅脑MRI T_2加权像检查具有简便、准确、无创等优点,可作为脑脊液鼻漏瘘口定位诊断的重要参考;经鼻神经内镜手术用自体筋膜和组织修复瘘口是有效的治疗方法。Objective To investigate the diagnosis methods for fistula localization and treatment strategy for endoscopic surgery in the treatment of spontaneous cerebrospinal fluid rhinorrhea.Methods A retrospective analysis was performed for the clinical data of 21 patients with spontaneous cerebrospinal fluid rhinorrhea.All 21 patients underwent computed tomography(CT)and magnetic resonance imaging(MRI)examinations before surgery to determine the location of fistula orifice,and cerebrospinal fluid rhinorrhea was repaired by neuroendoscopy through the transnasal approach.Results CT and T 2-weighted MRI examinations in different body positions were performed,and the position of fistula orifice was successfully determined for 20 patients,which was verified by surgery.The patients were followed up for 3 months to 3 years after surgery,and of all patients,19 were cured and 2 experienced recurrence and were cured after the second surgery.No surgical complications were observed.Conclusion Skull-base CT and T 2-weighted brain MRI in different body positions are simple,accurate,and noninvasive and can be used as an important reference for the localization of fistula orifice in patients with cerebrospinal fluid rhinorrhea.Transnasal neuroendoscopy using autologous fascia and tissue is an effective method to repair fistula orifice.

关 键 词：脑脊液鼻漏 瘘口 诊断 体层摄影术 X线计算机 磁共振成像 神经内窥镜检查 

分 类 号：R765.24[医药卫生—耳鼻咽喉科] R651[医药卫生—临床医学]