内镜经鼻斜坡恶性肿瘤切除术中脑脊液漏的修补策略  

Repair protocol of intraoperative CSF leak after endoscopic endonasal clival malignancy resection

作　　者：危维[1] 张秋航[1] 严波[1] 齐岩[1] 孟繁玥 王蠡 刘俊其[1] 杨晓彤[1] 王振霖[1] Wei Wei;Zhang Qiuhang;Yan Bo;Qi Yan;Meng Fanyue;Wang Li;Liu Junqi;Yang Xiaotong;Wang Zhenlin(Department of Otorhinolaryngology Head and Neck Surgery,XuanWu Hospital,Capital Medical University,Beijing100053,China)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,北京100053

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第11期1152-1158,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：首都卫生发展科研专项(2024-2-20110);北京市医院管理中心“登峰”计划专项(2024)。

摘　　要：目的探讨内镜经鼻斜坡恶性肿瘤切除术中脑脊液漏的修补方式和效果, 并分析其并发症的危险因素。方法回顾2012年1月至2024年1月在首都医科大学宣武医院行内镜经鼻斜坡恶性肿瘤切除术, 且术中发生脑脊液漏的患者的临床资料。收集患者的病理结果、影像资料、硬脑膜缺损位置、术中脑脊液漏程度、修补材料、术后颅内感染等并发症情况、使用的抗生素类别、细菌培养及药敏结果、二次修补情况以及随访结果等资料。使用IBM SPSS 26软件, 分析其修补效果, 并对颅内感染等围手术期并发症进行统计分析。结果 28例患者共行31例次内镜经鼻斜坡恶性肿瘤切除术及36例次颅底重建术, 其中女性14例、男性14例, 年龄4~70岁, 中位年龄53岁。使用游离鼻甲黏膜瓣、游离鼻中隔黏膜瓣、带蒂鼻中隔瓣、阔筋膜-肌肉等自体材料进行修补, 26例一次修补成功, 5例行二次修补, 均获成功。术后颅内感染4例, 均治愈。随访3~146个月, 无迟发性脑脊液漏。初次修补失败患者的感染率显著高于修补成功的患者(Fisher精确检验, P<0.001)。结论依据患者情况使用不同的自体材料可有效修补内镜经鼻斜坡恶性肿瘤切除术中发生的脑脊液漏, 但其成功率仍待提高。重建失败后颅内感染风险显著升高, 需加以重视并及时处理。Objective To evaluate the repair protocols for intraoperative cerebrospinal fluid(CSF)leaks after endoscopic endonasal clival malignancy resection(EECR)and to analyze the risk factors of surgical complication.Methods The clinical data of patients who underwent EECR and had intraoperative CSF leaks in XuanWu Hospital,Capital Medical University between January 2012 and January 2024 were reviewed.The pathological results,imaging data,location of the dural defect,degree of intraoperative CSF leaks,repair materials,complications such as postoperative central nervous system(CNS)infections,types of antibiotics used,bacterial culture and drug sensitivity results,secondary repair,and follow-up results were collected.IBM SPSS 26 software was used to evaluate the effectiveness of the repair.Additionally,statistical analysis was conducted on perioperative complications such as CNS infections.Results Twenty-eight patients underwent 31 EECR and 36 skull base reconstructions.There were 14 females and 14 males,aged from 4 to 70 years old,with a median of 53 years.For the repair,autologous materials such as free turbinate flap,free nasoseptal flap,pedicled nasoseptal flap,and fascia lata combined with mashed muscle were used.Initial reconstruction was successful in 26 cases,while 5 patients required a second repair,which was also successful.Postoperatively CNS infections occurred in 4 patients,and all of whom were cured.Follow-up ranged from 3 to 146 months,with no delayed CSF leak reported.The infection rate was significantly higher in patients whose first repair failed compared to those whose repair was successful(Fisher exact test,P<0.001).Conclusions The use of different autologous materials based on the patient′s condition can effectively repair CSF leakage that occurs during EECR.Howerver,the success rate of initial repair requires improvement,as the risk of CNS infection significantly increases after a failed repair..

关 键 词：耳鼻喉外科手术 脑脊液漏 斜坡 肿瘤 

分 类 号：R739.62[医药卫生—肿瘤]