经鼻内窥镜脑脊液鼻漏修补术

Cerebrospinal fluid rhinorrhea repairings under endoscope

目的 :探讨经鼻内窥镜修补脑脊液鼻漏的操作技巧及疗效。方法 :经鼻内窥镜手术修补脑脊液鼻漏 12例 ,在鼻内窥镜直视下寻找漏口 ,处理漏口周围黏膜 ,应用肌浆、鼻中隔和中鼻甲黏膜瓣、明胶海绵及EC耳脑胶或生物蛋白胶等修补漏口 ,用湿润烧伤膏油纱条填塞鼻腔 ,术后 4～ 10d抽取纱条。结果 :12例脑脊液鼻漏均 1次修补成功。结论 :经鼻内窥镜修补脑脊液鼻漏具有微创、安全、复发率低等优点。

Objective:To explore the advantages and surgical techniques in endoscopic repairings of cerebrospinal fluid(CSF) rhinorrhea.Methods: Twelve cases of CSF rhinorrhea were treated under endoscope. Different surgical techniques had been used for the transnasal surgical approach to CSF fistulas. The most important process of the surgery was ensuring the location of the fistulas under endsocope, and then elevated and resected the surrounding mucosa of fistulas in all direction. The materials of grafts included muscle, mucosa graft of the middle turbinate or septum, mucoperiosteal graft of the septum or middle turbinate or fascia-lata. Fibrin glue was used as a tissue adhesive, and placed layers of gelfoam over grafts, and packed nasal cavity with petrolatum ribbon gauze soaked MeBo ointment to secure adequate support .The stuffing were kept in place for 4～10 days. Results: The successful repairings were accomplished in all of the 12 CSF fistulas treated surgically, with a 100% closure rate after a single surgical procedure. Conclusion: The transnasal endoscopic repair of CSF rhinorrhea has a high successful rate and a low morbidity rate . It should be a first choice for all surgical cases.