经鼻内镜脑脊液鼻漏修补术中漏口定位分析

Analysis of ventage location in endoscopic repair of CSF rhinorrhea

目的探讨经鼻内镜脑脊液鼻漏修补术中准确寻找漏口的相关问题。方法回顾性研究12例漏口难以判断的脑脊液鼻漏患者，采用术前鼻内镜检查、核素扫描、术中影像导航系统定位以及椎管内注入生理盐水等方法判断漏口位置。结果12例患者术前核素扫描提示有脑脊液从鼻腔漏出，3例可疑蝶窦漏出，9例可疑筛窦漏出。蝶窦漏出的3例中，2例位于蝶窦侧壁，1例位于蝶窦后壁，其中2例经椎管内分别注入生理盐水15和20ml后发现漏口。9例可疑筛窦漏出的患者，在影像导航辅助下行筛窦轮廓化后，3例可见明确漏口（有清亮液体流出），另外6例于术中经椎管内分别注入生理盐水20～30ml后暴露漏口。结论经鼻内镜脑脊液鼻漏修补术中，对于漏口部位较难判断的患者，采用术前核素扫描、术中影像导航定位及椎管内注入适量生理盐水寻找漏口均为安全有效的方法，可为手术的成功奠定基础。

Objective To investigate the sites of cerebrospinal fluid （CSF） rhinorrhea via endoscopic treatment. Methods A total of 12 patients with hard-diagnosed-CSF rhinorrhea were included in the retrospective analysis. Preoperative endoscopy and isotope scanning, intraoperative image guiding system and intraspinal saline injection were performed to determine the ventage locations. Results Among the 12 cases of CSF rhinorrhea, isotope scanning showed that 3 ventages were located in the sphenoid sinus while other 9 ventages were located in the ethmoid sinus. In 3 cases of CSF rhinorrhea in sphenoid sinus, 2 ventages were located at the lateral wall and 1 ventage at the back wall. As to 9 cases of CSF rhinorrhea in ethmoid sinus, 3 ventages were identified with the aid of image guiding system, while other 6 ventages were identified by the intraspinal injection of normal saline. Conclusion Isotope scanning, image guiding system and intraspinal saline injection can effectively identify the ventages in surgical treatment of CSF rhinorrhea, and lay the foundation for successful diagnosis and treatment.