经鼻内镜脑脊液鼻漏修补术15例

Intranasal endoscopic repair of 15 cases of cerebrospinal fluid rhinorrhea

目的:总结鼻内镜治疗脑脊液鼻漏的要点及可靠的诊断定位方法。方法:回顾性分析15例脑脊液鼻漏患者,其中外伤引起者10例,医源性4例,原发性1例。其中6例经2～6周保守治疗无明显好转给予经鼻内镜下修补术;2例外伤性脑脊液鼻漏经神经外科开颅修补失败后转入我科手术治疗;1例复杂的多发性颅底骨折并双侧额窦后壁缺损致脑脊液鼻漏,经鼻内镜修补成功(DraftⅢ型)。缺损最大者2.5 cm×1.5 cm,所有患者术前均经实验室生化检查确诊,均予以CT和(或)MRI检查和经鼻内镜检查。10例给予脑池造影结合超薄螺旋CT扫描。结果:所有患者均一次治愈,平均随访时间20个月(8～40个月),无复发。1例术后有轻微头疼,经保守治疗后缓解。脑池造影结合超薄螺旋CT扫描定位精确,10例均经术中确定。结论:鼻内镜下脑脊液鼻漏修补术是外科治疗脑脊液鼻漏的首选术式。脑池造影结合超薄螺旋CT扫描是目前最好的影像学定位方法。随着鼻内镜相关器械质量提高及新器械的开发应用,手术范围可能进一步扩大。

Objective：To summarize endoscopic management of cerebrospinal rhinorrhea and position-determining means.Method：Fifteen cases of cerebrospinal rhinorrhea treated by endoscopic approach at our institution were analyzed retrospectively.Aetiology included accidental trauma（10）,surgical trauma（4）,idiopathic（1）.All patients presented with CSF rhinorrhea.Six cases were operated after failure of conservative treatment.Two cases after failure of neurosurgical repair were referred to our department.The largest defect was as big as 2.5 cm×1.5 cm.All patients were scanned by computed tomography and magnetic resonance imaging and confirmed by biochemistry test.Ten patients received high resolution spiral computed tomography bonding ventriculography.Result：We performed intranasal endoscopic repair in all 15 patients.All repairs were successful at the first attempt with a mean follow up of 20 months.One patient had light headache postoperatively and relieved with conservative treatment.All defects of skull base detected by computed tomography and ventriculography were confirmed in the operation.Conclusion：Intranasal endoscopic repair of cerebrospinal rhinorrhea can be an effective method.High resolution spiral computed tomography scan combined with ventriculography is a precise position-determining means.With the advancement of instrument and operative skill,the scope of endoscopic repair will further extend.