空蝶鞍合并脑脊液鼻漏的特点及临床治疗

The characteristics and treatment of empty sella combined cerebrospinal fluid leakage of nasal

目的:探讨空蝶鞍合并脑脊液鼻漏的特点及治疗方法。方法:空蝶鞍合并脑脊液鼻漏患者8例,其中2例行1次脑脊液鼻漏修补术,4例行2次鼻内镜下脑脊液鼻漏修补手术,1例行开颅联合鼻内镜脑脊液鼻漏修补术及脑室腹腔分流术,1例行鼻内镜脑脊液鼻漏修补术复发后保守治疗治愈。部分患者术后行腰大池引流1周,卧床3周。结果:1例患者术后出现脑出血,行开颅手术后治愈,随访2年未复发;1例术后2年复发,保守治疗治愈;2例在3年后复发,再次手术1年未复发;1例1年后复发,再次手术修补并行脑室腹腔分流术后半年未复发;1例患者术后半年未复发;1例患者术后5年复发,后再次手术。结论:空蝶鞍合并脑脊液鼻漏的患者临床上少见,治疗以鼻内镜手术修补为主,但术后易复发,反复发作者可以考虑行脑室腹腔分流术。术后需长期随访复查。

Objective：To study the feature and treatment method of patients with empty sella merger cerebrospinal fluid leakage of nasal.Method：There were 8 cases with empty sella merger cerebrospinal fluid leakage of nasal,2 cases were accepted the repairing surgery of cerebrospinal fluid leakage one time,4 cases were accepted the repairing surgery of cerebrospinal fluid leakage used endoscope 2 times,1 case was accepted repairing surgery of cerebrospinal fluid leakage used endoscope merge craniotomy and ventricle celiac bypass,1 case recurrenced after repairing surgery of cerebrospinal fluid was recured after conservative treatment.Some postoperative were stayed in bed for three weeks and lumbar drainage for 1 week.Result：One case of cerebral hemorrhage after surgery was cured with craniotomy,followed for 2 years without recurrence.One case was recured after conservative treatment.Two cases recurrenced after surgery 3 years ago were accepted surgery again followed by one year without recurrence.One case who recurrence 1 year later was accepted repairing surgery of cerebrospinal fluid leakage used endoscope merge craniotomy and ventricle celiac bypass followed six months without recurrence.One case after once surgery was followed half a year without recurrence.One case with recurrene 5 years later was accepted repairing surgery again.Conclusion：The patient with empty sella combined cerebrospinal fluid leakage of nasal was rare,the main methed was endoscopic sinus surgery treatment,but it recurred usually.The patients with repeatedly recurrene can be considered to accepted the surgery of ventricle celiac bypass.It required long-term postoperative follow-up and review.