经鼻内镜手术治疗脑脊液鼻漏

Endoscopic transnasal surgery for treatment of cerebrospinal fluid rhinorrhea

目的探讨脑脊液鼻漏经鼻内镜手术的可行性与疗效。方法与结果2011年11月至2018年6月共198例脑脊液鼻漏患者施行经鼻内镜脑脊液鼻漏修补术,其中191例修补成功,首次修补成功率为96.46%(191/198);复发者占3.54%(7/198),经二次修补成功封堵漏口。术后14例(7.07%)发生颅内感染,经抗生素治疗痊愈;1例(0.51%)右下肢深静脉血栓形成和2例(1.01%)双下肢肌间静脉血栓形成,予低分子量肝素抗凝治疗;1例(0.51%)因感染性休克死亡。平均随访(36.27±15.36)个月,无脑脊液鼻漏复发。结论经鼻内镜脑脊液鼻漏修补术成功率较高、创伤较小,颅内感染为术后主要并发症,应积极预防。

Objective To explore the feasibility and curative effect of endoscopic transnasal surgery in the treatment of cerebrospinal fluid(CSF) rhinorrhea. Methods and Results From November2011 to June 2018, a total of 198 patients with CSF rhinorrhea underwent endoscopic transnasal surgery in our hospital. There were 191 cases being repaired successfully in the first surgery, and the success rate of primary repair was 96.46%(191/198). Postoperative rhinorrhea recurred in 7 cases(3.54%, 7/198), and they were repaired successfully in the second surgery. After operation, 14 cases(7.07%) suffered from intracranial infection, and were cured by antibiotic therapy. One case(0.51%) with deep venous thrombosis of right lower limb and 2 cases(1.01%) with intermuscular venous thrombosis of lower limbs were treated by low molecular heparin anticoagulant therapy. One case(0.51%) died of septic shock. All survival patients were followed up for(36.27 ± 15.36) months, and none of them relapsed. Conclusions Endoscopic transnasal surgery has a high success rate and less trauma in the repair of CSF rhinorrhea.Postoperative intracranial infection should be prevented as the main postoperative complication.