脑脊液鼻漏的诊断及手术治疗28例临床分析

Diagnosis and treatment of cerebrospinal rhinorrhea:A clinical analysis of 28 cases

目的探讨脑脊液鼻漏的诊断及手术治疗方法。方法回顾性分析潍坊市人民医院与聊城市人民医院2005-2010年收治的28例脑脊液鼻漏患者资料,其中男性18例,女性10例,年龄18~59岁,平均年龄38岁,病程7d^2年;外伤性脑脊液鼻漏20例,自发性6例,医源性2例。结合生化检查、CT/MRI及鼻内窥镜检查明确诊断,修复材料为鼻中隔黏膜(18例)、颞肌筋膜(8例)、额部带蒂骨膜瓣(2例)。结果 28例均在鼻内镜下修补成功,其中1次修补成功26例,2例经再次修补成功,2例术后嗅觉明显减退,1例治疗后好转,1例无效;所有患者无鼻塞及鼻腔干燥等并发症,随访6~36个月未见复发。结论脑脊液鼻漏的准确诊断及修补方式和修补材料的正确选择是手术成功的关键。

Objective To study the diagnosis and surgical treatment of cerebrospinal fluid （CSF） rhinorrhea. Methods Clinical data about 28 CSF rhinorrhea patients （18 males and 10 females） aged 18-59 years with a disease course of 7 days-2 years, admitted to Weifang and Liaocheng People＇s Hospitals from 2005 to 2010, were retrospectively analyzed. Of the 28 patients, 20 were diagnosed with traumatic CSF leakage, 6 were diagnosed with spontaneous CSF leakage, and 2 were diagnosed with iatrogenic leakage. Their diagnoses were established by CT/MRI and nasal endoscopy in combination with biochemical testing. CSF rhinorrhea was repaired with nasal septum mucosa in 18 patients, with temporal fascia in 8 patients and with pedicle periosteal flap in 2 patients. Results Of the 28 patients with their CSF rhinorrhea successfully repaired under nasal endoscope, 26 were cured after the first repair and 2 underwent a second repair. The auditory was significantly reduced after repair in 2 patients, which was improved in 1 patient and did not improve in the other after treatment. No complications such as nasal obstruction and dry nasal cavity were observed. The patients were followed up for 6 -36 months during which no relapse occurred. Conclusion The accurate diagnosis and correct selection of renair nrocedure and materials are the keys to the successful repair of CSF rhinorrhea.