脑脊液鼻漏术前影像学漏口定位的临床研究

Clinical studies of the effect of pre-operation imaging assessment on localization of cerebrospinal rhinorrhea

目的:研究脑脊液鼻漏术前影像学漏口定位的方法,并探讨依据影像学检查的结果选择相应的手术方式以提高手术治疗效果的可行性。方法:32例行手术治疗的脑脊液鼻漏病例术前均行高分辨率CT(HRCT)与MR脑池造影术(MRC)检查,并根据检查结果选择相应的手术方式,并对照手术结果分析HRCT、MRC和结合两种检查方法后的术前鼻漏漏口定位的特异性和准确性。同时,根据术后随访结果分析影像学漏口定位指导下手术治疗的效果。结果:HRCT、MRC术前脑脊液鼻漏漏口定位的准确度分别为82%和84%,结合两种检查结果的准确率为95%;同时经统计学分析,HRCT、MRC和结合两者的术前脑脊液鼻漏漏口定位与手术漏口探察结果之间存在显著性差异(P<0.05)。术后随访27例,发现术前行HRCT、MRC检查鼻漏漏口定位,并根据检查结果选择相应的手术方式、指导术中的漏口修补,能够提高手术治疗成功率。结论:HRCT与MRC两者结合能够较准确的进行脑脊液鼻漏漏口定位,采用HRCT与MRC二者结合作为术前漏口定位手段,并根据检查结果选择相应的手术方式、指导术中的漏口探察与修补,能够提高手术治疗的成功率。

Objective： To study the effect of pre - operation imaging assessment on localization of cerebrospinal rhinorrhea, and to ex- plore the feasibility of operation - approach decision accord - ing to images. Methods： 32 patients with cerebrospinal rhinorrhea were done high - resolution CT and MRC images before operation by which we selected properly operative approaches. Finishing operation, We retro- gressively analyzed the specificity and accuracy of pre - operation rhinorrhea - localization by HRCT or MRC images or by both of them. Mo- reover, according to follow - up results after operation, we analysed the effect of operative treatment under rhinorrhea - localization by the ima- ges. Results： The accuracy rating of pre - operation rhinorrhea - localization by CT and MRC were 82% and 84% respectively, was 95% by both of them. There are significant difference of pre - operation rhinorrhea - localization and operation rhinorrhea - localization in HRCT or MRC or both of them. Conclusion： Integrating the high - resolution CT and MRC images together for analysis will dentify the cerebrospinal rhinorrhea more effectively and help the doctors to decide the operation approach more efficiently than by any of them alone.