硬膜间断缝合技术在经鼻内镜颅底重建的应用  

Interrupted dural suture for skull base reconstruction via endoscopic endonasal approach

作　　者：周春辉 董超[1] 皇甫罗锴 曲志峰 赵虎林 张剑宁 Zhou Chunhui;Dong Chao;Huangfu Luokai;Qu Zhifeng;Zhao Hulin;Zhang Jianning(Department of Neurosurgery,PLA General Hospital,Beijing 100048,China;Medical School of Chinese PLA,Beijing 100853,China)

机构地区：[1]解放军总医院神经外科学部,北京100048 [2]解放军医学院,北京100853

出　　处：《中国微侵袭神经外科杂志》2021年第6期250-253,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都卫生发展科研专项项目(编号:首发2020-4-5116)。

摘　　要：目的探讨硬膜间断缝合技术在经鼻内镜颅底重建的应用价值。方法回顾性分析92例行内镜经鼻手术治疗中线颅底占位病例资料,均在常规经鼻内镜颅底重建中联合硬膜间断缝合技术。观察术中脑脊液漏分级,术后脑脊液漏与颅内感染等情况。结果术中出现脑脊液漏49例。术后脑脊液漏6例,脑脊液漏发生率:0~Ⅰ级1.4%(1/70),Ⅱ~Ⅲ级22.7%(5/22)。合并颅内感染5例,3例经抗感染及腰大池引流后治愈,2例再次行经鼻手术修补术,其中1例死亡。病人均随访6个月,无迟发性脑脊液漏发生。结论常规经鼻内镜颅底重建联合硬膜间断缝合技术,可有效降低术后脑脊液漏发生率。Objective To explore the application value of interrupted dural suture technique in transnasal endoscopic skull base reconstruction.Methods The clinical data of 92 patients undergoing transnasal endoscopic surgery for midline skull base occupied cases were analyzed retrospectively,all of them were treated by interrupted dural suture technique in the conventional transnasal endoscopic skull base reconstruction.The grade of intraoperative cerebrospinal fluid(CSF)leakage,postoperative CSF leakage and intracranial infection were observed.Results The intraoperative CSF leakage occurred in 49 cases.There were 6 cases of postoperative CSF leakage,the incidence rate was 1.4%(1/70)for grades 0 toⅠ,and 22.7%(5/22)for gradesⅡtoⅢ.There were 5 patients with intracranial infection,3 patients recovered after anti-infective and lumbar drainage,the other 2 cases underwent second repair via transnasal approach,and 1 of them died.All the patients were followed up for 6 months without delayed CSF leakage.Conclusion Interrupted dural suture combined with conventional transnasal endoscopic skull base reconstruction can effectively reduce the incidence of postoperative CSF leakage.

关 键 词：神经内镜 颅底重建 脑脊液漏 经鼻蝶手术 

分 类 号：R651.11[医药卫生—外科学]