鼻中隔黏骨膜瓣在修补前颅底部分缺损中的应用

Application of mucoperiosteal flap of nasal septum and inferior nasal meatus to repair the anterior skull base defect

目的:探讨利用鼻中隔和下鼻道黏骨膜瓣对前颅底缺损的修补。方法:对9例鼻腔、鼻窦肿瘤患者和1例自发性脑脊液鼻漏患者,根据肿瘤性质及病变范围,经鼻侧切开行上颌骨部分截除(或全部截除)加筛窦切除术,或上颌骨部分截除(或全部截除)加眶内容剜除术。应用鼻中隔和下鼻道黏骨膜瓣对颅底缺损进行修补。结果:10例患者中,筛骨水平板破坏5例,筛顶破坏2例,眶顶壁破坏2例,筛骨水平板和蝶窦顶壁联合破坏1例,均在手术切除肿瘤后同步修补成功。结论:在鼻腔、鼻窦肿瘤的手术中,当前颅底骨质受到肿瘤侵蚀、切除肿瘤后形成脑脊液鼻漏时,可转移适当的鼻中隔和下鼻道黏骨膜瓣同步修补前颅底骨质缺损。

Objective：To investigate the neoplasty of cerebrosplnal rhlnorrhea（CSR） Dy making use of mucoperiosteal flap of nasal septum and inferior nasal meatus. Method.. A retrospective study was reviewed in 9 patients with tumors in nasal cavity and nasal sinuses and in 1 patient with spontaneous cerebrospinal rhinorrea. Anterior skull base defects were repaired synchronously on the heels of resection of the tumors which damaged anterior basis crania except for 1 patient with spontaneous cerebrospinal rhinorrea which was restored directly. Result.. Among the 10 patients there were 5 patients with the destruction on ethmoidal horizontal plate , 2 patients with the destruction on hanging wall of ethmoid, 2 patients with the destruction on hanging wall of fossa orbitalis, 1 patient with the destruction on ethmoidal horizontal plate and on hanging wall of sphenoidal sinus simultaneously and all the destructions were repaired following detection of it synchronously. Conclusiont During the operation of tumors in nasal cavity and/or nasal sinuses when anterior skull base defect is found and the CSR occurs we can take advantage of mucoperiosteal flap of nasal septum and inferior nasal meatus to perform the transplantation of mucoperiosteal flap in order to avoid forming cerebrospinal rhinorrea.