鼻内镜下脑脊液鼻漏修补方法的探讨

Analyze the role of endoscopic operation in the cerebrospinal fluid rhinorrhea repair

目的:探讨鼻内镜下脑脊液(CSF)鼻漏修补术中,由于漏口大小及部位的不同而采用的不同修补方 法对疗效的影响。方法:回顾性分析32例鼻内镜下CSF患者的漏口大小,修补方法及术后疗效。结果:①漏口 大小:1mm×1mm～20mm×20mm;②修补方法:浴缸塞法2例,外贴法10例,内贴法18例,筋膜加骨瓣钮扣 法1例。1次手术成功29例,2次成功1例,3次成功1例,1例修补失败由神经外科径口鼻蝶窦边路显微镜手术 成功。结论:①外贴法较为简便,适合较小的漏口;内贴法对抗颅内压较为理想,适合中等大小的漏口修补;浴缸 塞法对于中小漏口的修补疗效较可靠;“钮扣”法较适合修补较大的漏口。②鼻内镜下修补CSF鼻漏具有创伤 小、操作简单、视野清楚、成功率高、并发症少等优点。

Objective:To explore the effect of the different operative methods on the results with endoscopy in the cerebrospinal fluid rhinorrhea according to different location and different size.Method:All clinical records and data were studied retrospectively, compare repair measure under different size and different location of fistula.Result:①Size of fistulas: 1 mm×1 mm～20 mm×20 mm;②Repair methods:2 cases were repaired by 'Bath-plug' method, 10 by onlay, 18 by underlay, and 1 by 'Button with fascia'.Conclusion:①The suitable repair methods were selected according to size and location.Underlay is superior to resist intracranial pressure and better for middl size fistula. Onlay is simple and fit to small fistula. 'Bath-plug' method was more reliable for the small-middle size fistula. 'Button with fascia' was more suitable to large size fistula.②Advantages of the endoscopic technique include exact identification of the site of the dural tear,excellent field of vision, less complication and precise placement of graft.