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摘要: 目的:总结脑脊液鼻漏的治疗经验。方法:回顾性分析16例脑脊液鼻漏患者的临床资料,探讨脑脊液鼻漏的病因、影像学特点及漏口位置、大小、修复方法对疗效的影响。结果:16例患者中自发性脑脊液鼻漏10例,外伤性脑脊液鼻漏2例,感冒后出现脑脊液鼻漏3例,脑膜脑膨出伴脑脊液鼻漏1例。CT检查明确漏口位置11例,磁共振水成像检查明确漏口位置7例。漏口位于额窦3例,鼻腔顶部3例,筛顶6例,蝶窦4例。手术均在鼻内镜下完成,修补材料均采用自体材料;均一次修复成功,无手术并发症发生。随访10~42个月,无一例复发。结论:术前应用CT和磁共振水成像能准确判断脑脊液鼻漏漏口的位置、大小,术中修补材料的选择、漏口周围移植床的处理及修补材料与移植床的完全接触是确保手术成功的重要因素。Abstract: Objective:To summarize the clinical experience of endoscopic repair for cerebrospinal fluid (CSF) rhinorrhea in our department in the last 4 years. Method:Clinical data of 16 patients with CSF rhinorrhea who underwent nasal endoscopic repair was analyzed retrospectively. The effect of etiology, image data, location of CSF leaks and surgical techniques on treatment were discussed. Result:Among the 16 patients, 10 were diagnosed with spontaneous CSF rhinorrhea, 2 were diagnosed with traumatic CSF rhinorrhea, 3 were diagnosed with CSF rhinorrhea after catching cold and 1 was diagnosed with meningo-encephalocele in with CSF rhinorrhea. The leak was located by CT scan in 11 cases, by MRI in 7 cases. The common locations of the defect were the frontal sinus(3 cases), cribriform roof(3 cases), sphenoid sinus(6 cases) and the nasal cavity top(4 cases). All the cases were successfully cured after the first nasal endoscopic repair with autologous materials. None of patients had a reoccurrence during 10 to 42 months follow-up time. Conclusion:The application of CT and MRC before surgery which could make an accurate diagnosis of the location and the size of the defect.The correct selection of repair materials, processing planting bed around the leakage and complete contacting leakage with graft bed are the key points to the successful surgery of CSF rhinorrhea.
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Key words:
- cerebrospinal fluid rhinorrhea /
- endoscopy
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[1] GIDDINGS N A, BRACKMANN D E.Surgical treatment of difficult cerebrospinal fluid otorhinorrhea[J].Am J Otol, 1994, 15:781-784.
[2] MARTÍN-MARTÍN C, MARTÍNEZ-CAPOCCIONI G, SERRAMITO-GARCÍA R, et al.Surgical challenge:endoscopic repair of cerebrospinal fluid leak[J].BMC Res Notes, 2012, 5:459-465.
[3] SONI R S, CHOUDHRY O J, LIU J K, et al.Postoperative cerebrospinal fluid leak after septoplasty:a potential complication of occult anterior skull base encephalocele[J].Allergy Rhinol, 2013, 4:e41-e41.
[4] KONG Y G, DENG Y Q, WANG Y.Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea:an analysis of 22cases[J].Indian J Otolaryngol Head Neck Surg, 2013, 65:409-414.
[5] SOLER Z M, SCHLOSSER R J.Spontaneous cerebrospinal fluid leak and management of intracranial pressure[J].Adv Otorhinolaryngol, 2013, 74:92-103.
[6] DEENADAYAL D S, VIDYASAGAR D, KUMAR M N, et al.Spontaneous CSF rhinorrhea our experience[J].Indian J Otolaryngol Head Neck Surg, 2013, 65:271-275.
[7] QIAO L, XUE T, ZHA D, et al.Determining leak locations during transnasal endoscopic repair of cerebrospinal fluid rhinorrhea[J].Auris Nasus Larynx, 2011, 38:335-339.
[8] STONE J A, CASTILLO M, NEELON B, et al.Evaluation of CSF leaks:high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography[J].Am J neuroradiol, 1999, 20:706-712.
[9] LUND V J, SAVY L, LLOYD G, et al.Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhoea[J].J Laryngol Otol, 2000, 114:988-992.
[10] 郭文梅, 夏爽.脑脊液鼻漏的CT及MRI的检查技术和表现[J].实用放射学杂, 2009, 25 (12):1727-1729.
[11] WOODWORTH B A, PALMER J N.Spontaneous cerebrospinal fluid leaks[J].Current Opinion Otolaryngol Head Neck Surg, 2009, 17:59-65.
[12] EL-BANHAWY O A, HALAKA A N, ALTUWAIJRI M A, et al.Long-term outcome of endonasal endoscopic skull base reconstruction with nasal turbinate graft[J].Skull Base, 2008, 18:297-308.
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