医源性脑脊液鼻漏的成因及鼻内镜下手术修补术

Casuses and intranasal endoscopic repair of iatrogeuic cerebrospinal fluid rhinorrhea

目的 分析医源性脑脊液鼻漏（ICFR）发生的相关原因以及提高鼻内镜下修补术成功率的手术技巧。方法 回顾性分析1992年4月—2012年12月医治的53例ICFR患者的临床资料，其中40例用腹壁脂肪制成哑铃球状修补，4例加用中鼻甲黏膜瓣转移修复，9例加用鼻中隔黏骨膜瓣转移修复，脑脊液鼻漏修补手术均在鼻内镜下完成；对53例ICFR发生原因进行总结分析。结果 53例患者ICFR的原因分别为：术者术前局部解剖结构了解不充分19例、手术操作不当20例、取瘤时操作不当12例、术中发现脑脊液漏而修补不完全者49例。本组53例中，50例一次修补成功，3例二次修补成功，治愈率为100％。结论 经鼻内镜下脑脊液鼻漏修补术是ICFR修补的首选进路。术者术前对局部解剖结构了解不充分、手术操作不当、取瘤时操作不当、术中发现脑脊液漏修补不完全是造成ICFR的主要原因。

Objective To analyze the causes of iatrogenic cerebrospinal fluid rhinorrhea （ICFR） and improve the surgery skills of intranasal endoscopic neoplasty for this disease. Methods The clinical data of 53 cases of ICFR from April 1992 to December 2012 were analyzed retrospectively. Dumbbell shaped subcutaneous fat was used in 40 cases, middle concha mucosal flap was used in 4 cases, mucoperiosteum flap was used in 9 cases. All the operations were processed under intranasal endoscope. The causes of the 53 cases of ICFR were studied. Results The causes of the 53 cases of ICFR were： unfamiliarity with the anatomical structures of the patients in 19 cases, improper operation in 20 cases, carelessness while resecting tumors in 12 cases, and incomplete repair of CFR in 49 cases. The cerebrospinal fluid rhinorrhea was stopped after the first operation in 50 cases, and stopped after reoperation in the other 3 cases. Conclusions Unfamiliarity with anatomical structures, improper operation, carelessness, and unsuccessful repair are the main causes of ICFR. Intranasal endoscopic approach is the first choice of ICFR neoplasty.