经鼻内镜颅底缺损修补69例临床分析

Transnasal endoscopic repair of nasal-skull base defect:69 cases

目的总结经鼻内镜鼻颅底缺损修补的经验,评价鼻颅底缺损的病因、部位和经鼻内镜鼻颅底修补术的效果及关键技术。方法回顾性分析1998年1月至2006年6月69例鼻颅底缺损经鼻内镜颅底修补患者的临床资料,着重分析颅底缺损的病因、部位、手术效果及关键技术。结果随访6个月至11年,主要病因是外伤性颅底骨折(32例)、颅底或鼻-鼻窦占位性病变切除后(28例)和医源性颅底损伤(9例);主要部位在筛窦,其次是蝶窦;一次手术成功率为91.3%(63/69),最终成功率为95.7%(66/69)。结论经鼻内镜鼻颅底缺损修补术效果理想,缺损处彻底清创、制作缺损缘创面和修补物嵌塞于颅底内侧面是手术成功的关键,游离肌肉和筋膜是理想的修补材料。

Objective To summarize the experience of transnasal endoscopic repair of nasal-skull base defect. Methods The clinical data of 69 patients with transnasal endoscopic repair of skull base defect from January 1998 to June 2006 were analyzed retrospectively. The causes, sites of defect and the effect and key technique of transnasal endoscopic repair were investigated. Results All patients were followed-up for 6 months to 11 years. The causes were mainly traumatic fracture, occupying lesions and iatrogenic trauma. The sites were mainly in ethmoid sinus and sphenoid sinus. The success rate of one attempt was 91.3% （63/69） ,the ultimate success rate was 95.7% （66/69）. Conclusions Transnasal endoscopic repair of skull base defect may be the best approach. Debriding and raw edge of defect area and ＂inlay-plug＂ method are of key technique. The liber muscle and fascia are ideal repair material.