脑脊液鼻漏修补术的手术入路及修补材料选择(附54例报告)

Surgical approach and materials in reparation of cerebrospinal rhinorrhea (54 cases reports)

目的:探讨脑脊液鼻漏的各种手术进路及各种修补材料特点,选取最佳的手术径路及修补材料。方法:回顾性分析1983年3月～2001年6月间收治的54例持续性脑脊液鼻漏经各种入路进行修补治愈的临床资料。结果:鼻内镜成功率最高(93.3%),前颅窝入路最低(20.0%),颅外法与颅内法比较差异有统计学意义。带血管蒂帽状腱膜瓣及阔筋膜常用于术中修补瘘口。结论:鼻内镜入路是最佳入路,对颅底较大缺损的修补可采用额鼻联合入路及带血管蒂帽状腱膜瓣修补缺损。根据具体情况选择合适的径路及修补材料。

Objective;To find out the best surgical approach and repair material in repairing eerebrospinal rhinorrhea by comparing their characteristics. Method,. The clinical data of 54 eases from March 1983 to June 2001 with continuous eerebrospinal rhinorrhea treated by different approaches and repair materials were retrospective analyzed. Result;The highest recurrent rate was by anterior cranial fossa approach, while the lowest was by nasal endoscope. The bleeding volume in nasal endoscope approach was less than other surgical approaches with the significant differences （ P d0.01）, Galea frontalis myofaseial flap and fascia lata were often used to repair fistula in operation. Conclusion： Nasal endoscope is the best approach. Cranionasal combination approach can be used in eases with larger defect in basis crania by galea frontalis myofascial flap reparation, The proper approach and repair materials should be selected according to the practical situation.