外伤性额窦脑脊液鼻漏的治疗

Treatment of traumatic cerebrospinal rhinorrhea in frontal sinus

目的 探讨经鼻内窥镜外科治疗额窦脑脊液鼻漏的适应证、操作技巧及优点。方法 经鼻内窥镜外科治疗外伤性额窦脑脊液鼻漏 6例 ,利用经鼻内窥镜外科技术开放和扩大鼻额管 ,在直视下找到瘘口 ,应用自体碎肌肉覆盖瘘口 ,外加肌膜和明胶海棉、碘仿纱条填塞 ,对于单纯内窥镜下手术有困难者 ,结合眉弓小切口联合额窦切开进行修补。结果 6例外伤性额窦脑脊液鼻漏患者 ,4例采用经鼻内窥镜外科一次修补成功 ,1例采用经鼻内窥镜外科联合额窦切开修补成功 ,1例经鼻内窥镜修补术后失败 ,再次手术联合鼻外额窦切开修补成功。结论 经鼻内窥镜外科技术修补脑脊液鼻漏具有操作简单、容易确定瘘口、修补成功率高等优点 ,对于部分内窥镜下难于到达的部位 ,联合应用额窦切开可弥补内窥镜下操作困难和不足 ,有助于提高修补瘘口的成功率。

Objective To evaluate the indication, operative technique and advantages of the treatment of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery. Method Treatment of 6 cases of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery was reported. We adopt a procedure to open and enlarge the nasofrontal duct under direct vision by intranasal endoscopic surgery firstly and find the fistula, then repair it with its own smashed muscle, and support it with muscular membrane and gelfoam,iodoform pledget. Results Four cases were repaired successively in one procedure with intranasal endoscopic surgery, 2 cases were solved by combined external and intranasal procedure. Conclusions The advantages of treatment of traumatic cerebrospinal rhinorrhea in frontal sinus by intranasal endoscopic surgery included easily operation,easily confirmation of fistula and high success rate, combination of frontal sinuostomy may deal with its demerit to the unreachable site sometimes.