108例鼻内镜下脑脊液鼻漏修补术的临床分析

Endoscopic management of cerebrospinal fluid rhinorrhea,a single center experience

目的：回顾性分析108例鼻内镜下脑脊液鼻漏修补术的疗效、术后并发症以及复发的高危因素。方法：回顾性分析2001年6月至2015年7月收治的脑脊液鼻漏患者108例,其中外伤性68例、自发性40例,男性61例,女性47例,年龄2～58岁,平均年龄36岁。结果：一次性修补成功101例,2例患者再次鼻内镜修补成功,失访2例,死亡1例,随访3个月～6年无复发。脑脊液鼻漏患者漏口位置主要位于筛顶和筛板（78/108）,其次位于蝶窦（18/108）,额窦后壁12例。在外伤性脑脊液鼻漏组中,术后发生脑膜炎5例,感染率为7.2%,1例患者死亡;自发性脑脊液鼻漏组中术后脑膜炎1例,感染率为2.5%;漏口位于筛顶和筛板术后感染率为1.2%;漏口位于蝶窦术后感染率为5.5%;漏口位于额窦后壁术后4例出现颅内感染,感染率为33.3%（P〈0.05）。结论：鼻内镜下脑脊液鼻漏修补术是治疗脑脊液鼻漏的有效方法,颅内感染是其严重并发症,漏口位于额窦后壁的脑脊液鼻漏患者术后感染率明显高于其他部位,漏口大小和位置是术后发生脑膜炎的危险因素。

Objective：Retrospective analysis of efficacy,complications and the recurrence risk factors of 108 cases with endoscopic repair of cerebrospinal fluid rhinorrhea, nethods：108 cases of cerebrospinal fluid rhinorrhea admitted in our hospital from June 2061 to July 2015 were analyzed retrospectively, including 68 cases of traumatic and spontaneous 40 cases,61 cases of male, female,47 cases, aged from 2 to 58 years old,with an average age of 36 years old. Results：One-time repair successfully in 101 cases,2 cases of patients with nasal endoscopic repair success again,2 cases lost to follow-up, 1 case of death, followed up for 3 months to 6 years without recurrence. The leakage of cerebrospinal rhinorrhea were mainly located at the top sieve and sieve plate （78/108） ,the second is located in the sphenoid sinus （18/108） , 12 cases of frontal sinus wall after. In traumatic cerebrospinal fluid rhinorrhea group, postoperative meningitis occurred in 5 cases,the infection rate was 7.2% , 1 patient died; spontaneous cerebrospinal fluid rhinorrhea group in postop- erative meningitis （1 case） ,the infection rate was 2.5% ;leak in ethmoidal roof and sieve plate operation infection rate after 1.2% ; leak in sphenoid sinus postsurgery infection rate was 5.5% ;chute located in the posterior frontalsinus wall after operation 4 cases ap- pear intracranial infection,the infection rate was 33.3% （P 〈 0.05 ）. Conclusion：Endoscopic repair of cerebrospinal fluid rhinorrhea is an effective method for the treatment of cerebrospinal fluid rhinorrhea,intracranial infection is serious complications and ventage in frontal sinus after wall of cerebrospinal fluid rhinorrhea patients after infection rate was higher than that in other parts,the leak size and location is postoperative meningitis risk factors.