鼻内镜下脂肪压塞技术修补前颅底脑脊液鼻漏和脑膜脑膨出

葛文彤; 倪鑫; 李云川; 张罗

doi:10.13201/j.issn.1001-1781.2013.15.002

鼻内镜下脂肪压塞技术修补前颅底脑脊液鼻漏和脑膜脑膨出

- 1. 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京, 100045);
- 2. 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科;
- 3. 北京市耳鼻咽喉科研究所教育部耳鼻咽喉头颈外科重点实验室
基金项目:
北京市科技新星项目经费资助(No:2006B31)

详细信息

通讯作者: 张罗,E-mail:luozhang@trhos.com

中图分类号: R651.1

收稿日期: 2013-01-15

Endoscopic transnasal approach for repairing anterior skull base cerbrospinal fluid rhinorrhea and meningoencephalocele: preliminary experience of using fat bath-plug technique

- 1. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China;
- 2. Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University;
- 3. Beijing Institute of Otorhinolaryngology, Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education

More Information

Corresponding author: ZHANG Luo, E-mail: luozhang@trhos.com

Received Date: 15 January 2013

摘要

摘要: 目的:总结经鼻径路内镜下脂肪压塞技术修补前颅底脑膜脑膨出和脑脊液鼻漏的初步经验。方法:接受经鼻内镜下脂肪压塞技术修补外伤性脑膜脑膨出患者1例,脑脊液鼻漏患者5例(外伤性1例,自发性4例);对术前和术中定位、手术过程、围手术期症状和随访情况等进行分析。结果:患者术前均经螺旋CT和MRI检查,6例术前均初步判定瘘孔位置,术中发现的瘘孔位置与术前影像定位一致;6例脑脊液鼻漏均一次修补成功;术后7d均无发热、无颅内感染征象;术后7d鼻腔填塞碘仿纱条出院,术后3~4周彻底清理鼻腔填充物,术后3、6个月内镜随访显示黏膜上皮化好;术后3年电话随访均无再漏、无颅内感染发生。结论:鼻内镜下脂肪压塞技术是修补前颅底特别是筛顶区域小型硬脑膜瘘孔的一种简便、安全的手术方式。
- 内镜检查 /
- 脑脊液鼻漏 /
- 脑膜脑膨出 /
- 前颅底 /
- 脂肪组织
Abstract: Objective:To summary the preliminary experience of fat bath-plug technique in endoscopic transnasal approach for repairing anterior skull base cerbrospinal fluid rhinorrhea(CSF) and meningoencephalocele.Method:Using fat bath-plug techique repair 1 case meningoencephalocele(traumatic) and 5 cases cerbrospinal fluid rhinorrhea(1 traumatic,4 spontaneous).The analysis index included: preoperative localization,intraoperative position,surgical procedures,perioperative symptoms,follow-up,etc.Result:CT and MRI techniques were used for location of the fistula preoperative.The location of the fistulas were explorationed during the operation and were consist with the imaging studies.All 6 fistulas were repaired during the first operation.No fever and no intracranial infection occurred postoperatively.All the patients discharged 7 days postoperatively with an iodoform nasal packing.Three to 4 weeks later the patients were reviewed to clean up the nasal cavity.All patients were recovered well with good epithelial mucosa in the 3 and 6 months endoscopic follow-ups.No CSF leak and intracranial infection happened in the 3-year telephone follow-up.Conclusion:The fat bath-plug technique in endoscopic transnasal approach for repairing anterior skull base small fistula,especially in cribriform ethmoid roof,is effective,safe and simple.
- endoscopy /
- cerebrospinal fluid rhinorrhea /
- meningoencephalocele /
- anterior skull base /
- fat tissue

HTML全文

参考文献(14)

[1]	韩德民,周兵.鼻内镜外科学[M].2版.北京:人民卫生出版社,2012:292-304.
[2]	李源,周兵.实用鼻内镜外科学技术及应用[M].北京:人民卫生出版社,2009:391-408,430-435.
[3]	WORMALD P J,MCDONOGH M.'Bath-plug'techniquefor the endoscopic management of cerebrospinal fluid leaks[J].J Laryngol Otol,1997,111:1042-1046.
[4]	Wormald,P J.韩德民.内镜鼻窦外科学——解剖学基础、CT三维重建和手术技术[M].2版.北京:人民卫生出版社,2010:161-171.
[5]	文卫平,许庚,张湘民,等.脑脊液鼻漏的治疗[J].中华耳鼻咽喉科杂志,2002,37(5):366-369.
[6]	袁洪,刘钢,赵绰然.脑脊液鼻漏的治疗——附82例报告[J].中国微创外科杂志,2002,2(5):338-339.
[7]	文卫平,李健,史剑波,等.经鼻内镜外伤性脑脊液鼻漏修补术[J].中国内镜杂志,2005,11(3):228-230.
[8]	张云高,王荣光,武文明,等.脑脊液鼻漏修补术的手术入路及修补材料选择(附54例报告)[J].临床耳鼻咽喉科杂志,2006,20(8):341-343.
[9]	刘丕楠,李永华,倪富强.经鼻内镜修补复发性脑脊液鼻漏及颅底缺损[J].临床耳鼻咽喉科杂志,2006,20(11):489-491.
[10]	古庆家,何刚,陈晓丹,等.经鼻内镜脑脊液鼻漏修补术及相关因素探讨[J].中国耳鼻咽喉颅底外科杂志,2011,17(1):51-53.
[11]	张立强,李学忠,史丽,等.鼻内镜下脑脊液鼻漏修补术[J].中华耳鼻咽喉头颈外科杂志,2012,47(1):34-38.
[12]	高下,陈峰,戴艳红,等.鼻内镜下自体肌肉筋膜加脂肪组织修补脑脊液鼻漏[J].中国耳鼻咽喉头颈外科,2007,14(11):682-683.
[13]	许庚,李源,谢民强,等.经鼻内镜手术治疗鼻部脑膜脑膨出[J].中华耳鼻咽喉科杂志,2003,38(1):47-49.
[14]	SCHLOSSER R J,BOLGER W E.Significance ofempty sella in cerebrospinal fluid leaks[J].OtolaryngolHead Neck Surg,2003,128:32-38.