鼻内镜下脑脊液鼻漏的治疗

目的总结鼻内镜下脑脊液鼻漏的治疗经验,探讨鼻内镜下定位和修复的方法。方法回顾分析6例脑脊液鼻漏病人诊治过程,对脑脊液鼻漏的定位及修复方法进行讨论。结果6例病人,男、女各3例,年龄28~45岁。医源性2例,外伤性2例,自发性脑脊液鼻漏2例。于鼻内镜下寻找漏出部位,发现位于颅前窝3例,位于蝶窦3例。以明胶海绵蘸生物蛋白胶加鼻黏膜修复4例,生物蛋白胶加肌肉、阔筋膜加脂肪、阔筋膜各1例。83%(5/6)1次修复成功、1例2次修复成功。结论鼻内镜下脑脊液鼻漏定位和修复具有方法简捷、疗效确切,推荐作为脑脊液鼻漏治疗的首选方法。

Endoscopic Surgical Treatment of Cerebrospinal Fluid Rhinorrhea

Objective:To summarize the clinical experience in Treating cerebrospinal fluid (CSF) rhinorrhea and to explore the transnasal endoscopic approach of locating CSF leak site and repairing CSF rhinorrhea.Methods: Six cases of CSF rhinorrhea were retrospectively studied to discuss about the approach of locating and repairing it.Results: Six cases of CSF rhinorrhea were 3 men and 3 women, from 28 to 45 years old .The etiology of CSF rhinorrhea respectively,2 cases;traumatic,2 cases; and spontaneous, 2 cases.By transnasal endoscope the leak sites were separately found in anterior cranial fossa, 3 cases;and in sphenoid sinus,3 cases.And four cases were repaired with gelatin sponge and fibrin glue(FG)and nasal mucosa, one case with skeletal muscle and fascia lata and FG, one case with fatal and fascia lata and FG.Finally endoscopic repair of CSF leaks was successful in 83%(5/6)of the cases after a first attempt;And one case CSF leaks(1/6)was closed after a second attempt.Conclusion: The method of repairing CSF rhinorrhea by transnasal endoscopc management has the advantages of convenience and best effectiveness, so we suggest it be used as the first choice in treatment CSF rhinorrhea.