Clinical analysis of transnasal endoscopic repair of cerebrospinal fluid rhinorrhea
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摘要: 目的:总结脑脊液鼻漏常见的临床类型及鼻内镜下脑脊液鼻漏修补术的要点,并评价治疗效果。方法:29例脑脊液鼻漏患者中,外伤性9例,自发性10例,肿瘤性7例,医源性3例。均在全身麻醉下行鼻内镜下脑脊液鼻漏修补术。结果:25例一次性修补成功。术后3例发生颅内感染,2例发生气颅,均经保守治疗痊愈。术后随访半年以上,所有患者未再发生脑脊液鼻漏。结论:鼻内镜下脑脊液鼻漏修补术安全有效,手术成功率高,不易复发,并发症少,可作为脑脊液鼻漏手术治疗的首选方式及有效预防措施。准确的漏口定位、合适的修补方式、有效的颅底重建、必要时持续腰大池引流及积极预防颅内感染是手术成功的关键。Abstract: Objective: To summarize the common clinical types of cerebrospinal fluid(CSF) rhinorrhea and key points of transnasal endoscopic repair of CSF rhinorrhea. To evaluate clinical effects. Method: In 29 patients with cerebrospinal fluid rhinorrhea, 9 patients with traumatic CSF rhinorrhea, 10 patients with spontaneous CSF rhinorrhea, 7 patients with CSF rhinorrhea after tumour excision, and 3 patients with iatrogenic CSF rhinorrhea. All the 29 patients were treated with transnasal endoscopic repair of CSF rhinorrhea. Result: There were 25 patients were successfully repaired at one time. Three patients developed intracranial infection and 2 patient developed pneumocephalus after surgery, all of them were cured with conservative treatment. All the patients who were followed-up for more than half a year had no recurrence.Conclusion: Transnasal endoscopic repair of CSF rhinorrhea is safe and effective, the success rate of operation is high, it is not easy to recur, and the complications are few. It can be used as the first choice for repairing of CSF rhinorrhea and effective prevention measures. Accurate location of leak, appropriate repair, effective reconstruction of the skull base, continuous drainage of the lumbar cistern when necessary and active prevention of intracranial infection are critical to the success of operation.
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