成人自发性脑脊液鼻漏诊治的临床分析

Clinical analysis of adult spontaneous cerebrospinal fluid rhinorrhea

目的:探讨成人自发性脑脊液鼻漏(CSFR)的临床特点、诊断及治疗方法。方法:18例CSFR患者,收集鼻腔漏出液送生化检查,影像学检查查找骨质缺损。结果:所有病例鼻腔漏出液葡萄糖浓度均>1.7mmol/L,免疫固定电泳技术检测β-2转铁蛋白阳性。12例CT显示颅底骨质缺损,6例未发现骨质缺损者MRI显示鼻窦内积液,信号与脑脊液相似,以此推测漏口位置。1例保守治疗有效,其余17例均在全身麻醉下行计算机辅助导航下鼻内镜下CSFR修补术,所有病例一次修补成功,术后随访11~24个月未见复发。结论:成人CSFR发病率低,易被漏诊及误诊。中老年肥胖女性居多,常合并高血压及糖尿病类基础疾病,无日常锻炼习惯,多伴有中重度骨质疏松。正确的病史采集、合理的术前检查及精确的术前定位对于手术修复至关重要。术中采取计算机辅助导航系统,有助于术者精确定位漏口位置,明显缩短手术时间。

Objective：To discuss the clinical characteristics,diagnosis and treatment of adult spontaneous cerebrospinal fluid rhinorrhea（CSFR）.Method：A retrospective study was conducted on 18 patients of CSFR.Nasal secretion was collected for biochemical analysis.Imaging examination was done for identification of the bony defect in skull base.Result：In all cases,the glucose concentration of nasal secretion were more than 1.7 mmol/L,and theβ-2 transferrin detected by immunoelectrophoresis technique were positive.Twelve cases were found to have bony defect in skull base.For the rest 6 cases without bony defect,MRI findings of 6 cases showed sinusoidal effusion with similar signals to cerebrospinal fluid,thus predicting the location of the leak.Conservative treatment was successful in one case,and the other 17 patients underwent endoscopic sinus surgery with computer assisted navigation system（CANS）.The results of all cases underwent surgery were successful by one time.No recurrence occured during the follow-up time（11 to 24 months）.Conclusion：The incidence of adult CSFR is low,hence it is easily to be missed and misdiagnosed.The majority of CSFR patients are middle-aged and elderly obese women,often combined with hypertension,diabetes,moderate and severe osteoporosis due to no daily exercise habits.Correct medical history collection,reasonable preoperative examination and accurate preoperative localization of bony defect are essential for surgical repairment.CANS used during operation can enable surgeons to locate the site of leakage accurately and shorten the operation time.