外伤性脑脊液鼻漏修补术38例治疗体会

Therapeutic effect of traumatic cerebrospinal fluid rhinorrhea under microscope: a 38 patients report

目的探讨在显微镜下治疗外伤性脑脊液鼻漏修补术的临床价值及意义。方法回顾性分析新乡市中心医院神经外科2012年12月至2014年10月在显微镜下治疗脑脊液鼻漏患者38例的经验和价值。结果 38例患者术前均准确定位漏口位置;经1次手术治疗修补成功33例;2例同时行颅骨缺损修补;2例患者由于多处骨折均2次修补成功;1例由于合并颅脑严重损伤及全身多发伤,术后死亡;1例患者鼻腔间断性脑脊液流出长达40 a伴多次颅内感染症状1次修补成功。37例回访患者除5例失访外,其余患者均未见再漏。结论外伤性脑脊液鼻漏经显微镜下重建颅底可获得良好效果,同时结合薄层电子计算机断层扫描及磁共振成像技术的准确定位可最大程度地提高手术成功率。

Objective To investigate the clinical value and significance of traumatic cerebrospinal fluid rhinorrhea re- pair surgery under the microscope. Methods Thirty-eight patients with cerebrospinal fluid rhinorrhea were treated under the microscope in the Department of Neurosurgery of Xinxiang Central Hospital from December 2012 to October 2014, and the treatment experience and value was analysed retrospectively. Results The leak location were accurately located in 38 patients before surgery. Thirty-three patients were repaired successful by once surgery; two patients simultaneously accepted skull defect repair surgery;two patients were repaired successful by twice surgery due to the multiple fractures;one patient died after sur- gery due to the consolidation of serious injury of brain and multiple injuries of body. One patient with nasal intermittent outflow of cerebrospinal fluid for 40 years and with multiple intracranial infection symptoms was repaired successfully by once surgery. Thirty-two patients were not appeared cerebrospinal fluid rhinorrhea （five patients were lost to follow-up）. Conclusion The reconstruction of skull base under microscope for treatment of the traumatic cerebrospinal fluid rhinorrhea has good effective- ness. At the same time, accurate positioning by thin-section computed tomography scan and magnetic resonance imaging tech- nology can maximize the success rate of surgery.