经鼻内镜脑脊液鼻漏修补术的方式和方法分析

Endoscopic repair of cerebrospinal fluid rhinorrhea

目的:探讨脑脊液鼻漏的最佳治疗方法。方法:45例经鼻内镜行脑脊液鼻漏修补术患者,42例经鼻进路,3例经鼻及鼻外双进路。采用患者自体游离阔筋膜、捣碎的肌肉,剥去骨质带骨膜的中鼻甲或下鼻甲作为修补移植物,修补采用内贴修补法、堵塞修补法、外贴修补法和充填修补法。结果:1次性手术修补成功44例(97.8%)。术后并发脑膜炎3例,额窦区感染皮瓣下积液1例。45例住院治疗7～30d,平均11d。随访5个月～7年,无复发。结论:对于前颅底小瘘口和鞍底、斜坡处瘘口的脑脊液鼻漏,经鼻内镜脑脊液鼻漏修补具有明显优势。修补方式、方法和修补材料的正确选择是修补成功的关键。

Objective：To investigate the best treatment of cerebrospinal fluid rhinorrhea. Method：A retrospective study of 45 consecutive patients who presented with CSF leak,was conducted. Forty-two patients were treated with transnasal endoscopic approach, three with double approach transnasal and extranasal. The fascia lata, the myoplasm, the free middle turbinate graft and the free inferior turbinate graft were used for fistula repairing. Four repair techniques as onlay technique,inlay technique, underlay technique and obliteration technique were used. Resuit：Postoperative follow-up lasted from 5 to 84 months. The overall success rate after the first operation was 97.8%. Three patients got meningitis,one patient got local infection in frontal sinus, but all of them were cured. Conclusion： In our study, The outcome was very good in endoscopic repair of a small fistula in anterior cerebrospinal, a fistula in dorsum sella and a fistula in slope with a free graft of autogenous. But it needed a perfect choose in operation approach, repair technique and graft material.