经鼻内镜脑脊液鼻漏修补探讨  

Endoscopic endonasal repair treatment of cerebrospinal fluid rhinorrhea

作　　者：付奕豪 周跃飞 杨双武 贾鹏飞 高大宽 FU Yihao;ZHOU Yuefei;YANG Shuangwu;JIA Pengfei;GAO Dakuan(Department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院神经外科,陕西西安710032

出　　处：《空军军医大学学报》2022年第4期436-439,共4页Journal of Air Force Medical University

基　　金：陕西省社会发展科技攻关项目重点项目(2018ZDXM-SF-086)。

摘　　要：目的探讨经鼻内镜脑脊液鼻漏修补术在治疗脑脊液鼻漏中的应用效果。方法回顾性分析2015年1月至2020年1月于西京医院行经鼻内镜脑脊液鼻漏修补术患者68例,术前使用CT、MRI、脑池核素显像和强T2扫描等多模态影像技术相结合明确漏口位置。高流量脑脊液鼻漏患者选用多层修补的方法,低流量脑脊液鼻漏患者单纯采取黏膜瓣修补。术后卧床1周,根据情况采取降颅压等治疗。结果66例患者一次性修补成功,治愈率为97.1%,2例患者二次修补后治愈,随访未见脑脊液漏复发。结论选择适当的经鼻内镜脑脊液鼻漏修补方法可以提高手术成功率,内镜下修补是一种治疗脑脊液鼻漏的可靠方法,值得临床普遍推广。Objective To discuss the curative effect of endoscopic endonasal cerebrospinal fluid rhinorrhea repair in the treatment of cerebrospinal fluid rhinorrhea.Methods The data of 68 cases who underwent endoscopic endonasal cerebrospinal fluid rhinorrhea repair in Xijing Hospital from January 2015 to January 2020 were collected in the retrospective analysis.A combination of multimodality imaging techniques was preoperatively used such as CT,MRI,cisternal radionuclide imaging,and strong T2 scanning to identify the leakage site.Multi-layer repair method was adopted on the patients with high flow cerebrospinal fluid rhinorrhea.Patients with low flow cerebrospinal fluid rhinorrhea were repaired with a vascularized nasoseptal flap.The patients were asked to lie in bed for one week postoperatively.If necessary,intracranial pressure reduction was performed.Results Sixty-six patients were successfully rapaired at the first time,and the cure rate was 97.1%.Two patients were cured through the second operation.No cerebrospinal fluid rhinorrhea recurred after the operation.Conclusion Rationally applying appropriate repair methods according to the flow rate of cerebrospinal fluid rhinorrhea can improve the success rate of surgery.Endoscopic cerebrospinal fluid rhinorrhea repair is a reliable method for the treatment of cerebrospinal fluid rhinorrhea,which is worthy of clinical promotion.

关 键 词：神经内镜 脑脊液鼻漏 颅底重建 颅底外科 

分 类 号：R651.1[医药卫生—外科学]