The application of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea
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摘要: 目的 探讨带蒂中鼻甲黏膜瓣在经鼻内镜修复脑脊液鼻漏手术中的应用及疗效。方法 回顾分析15例脑脊液鼻漏患者，其中单纯脑脊液鼻漏13例(86.7%)，脑脊液鼻漏伴脑膜脑膨出2例(13.3%)。术中根据瘘口位置采用经鼻内镜下带蒂中鼻甲黏膜瓣进行修复，其中漏口位于筛顶5例(33.3%)，漏口位于筛板8例(53.3%)，漏口位于蝶窦外侧隐窝2例(13.3%)。结果 术后随访4~24个月，手术成功率为100%，术区黏膜上皮化良好，未出现脑脊液鼻漏复发及其他并发症。结论 带蒂中鼻甲黏膜瓣修复脑脊液鼻漏手术成功率高，鼻腔损伤小，值得临床推广。Abstract: Objective To investigate the application and efficacy of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea.Methods 15 patients with cerebrospinal fluid rhinorrhea were retrospectively analyzed, including 13 patients with simple cerebrospinal fluid rhinorrhea (86.7%) and 2 patients with cerebrospinal fluid rhinorrhea with meningoencephalocele (13.3%). According to the location of the fistula, the pedicled middle turbinate mucosal flap under nasal endoscopy was used to repair cerebrospinal fluid rhinorrhea, in which 5 cases (33.3%) had leakage at the top of the sieve and 8 cases (53.3%) had leakage at the sieve plate. Two cases had leakage at the lateral racess of sphenoid sinus.Results All cases of cerebrospinal fluid rhinorrhea were repaired successful and the mucosa epithelialized well in the operative area. There was no recurrence of cerebrospinal fluid rhinorrhea or other complications during the follow-up period of 4-24 months (average 13 months).Conclusion The pedicled middle turbinate mucosal flap has a high success rate for repairing cerebrospinal fluid rhinorrhea, and the nasal cavity damage is small, which is worthy of clinical promotion.
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[1] 周奋, 潘德岳, 肖仕和, 等. 经颅修补术治疗脑脊液鼻漏并反复气颅[J]. 中华神经创伤外科电子杂志, 2019, 5(2): 126-128. https://www.cnki.com.cn/Article/CJFDTOTAL-SJCW201902023.htm
[2] Soni RS, Choudhry OJ, James K, et al. Postoperative Cerebrospinal Fluid Leak after Septoplasty: A Potential Complication of Occult Anterior Skull Base Encephalocele[J]. Allergy Rhinologys, 2013, 4(1): e41-e41.
[3] Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery[J]. Laryngoscope, 1992, 102(2): 198-202.
[4] Yadav YR, Parihar V, Janakiram N, et al. Endoscopic management of cerebrospinal fluid rhinorrhea[J]. Asian J Neurosurg, 2016, 11(3): 183-193. doi: 10.4103/1793-5482.145101
[5] 张胜男, 姜彦, 于龙刚, 等. 鼻内镜下脑脊液鼻漏修补术诊疗分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1189-1195, 1199. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201912019.htm
[6] 吴瑕, 王彦君, 乐建新, 等. 脑脊液鼻漏修补术成败的关键因素研究[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(9): 618-620. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH201409010.htm
[7] 中国医师协会内镜医师分会神经内镜专业委员会, 中国医师协会神经外科医师分会神经内镜专业委员会, 中国医师协会神经修复学专业委员会, 等. 神经内镜经鼻颅底手术中颅底重建技术专家共识[J]. 中华神经外科杂志, 2020, 36(11): 1081-1087.
[8] 陈晓栋, 石照辉, 李晓媛, 等. 随意黏膜瓣在经鼻内镜修补脑脊液鼻漏手术中的应用[J]. 中国眼耳鼻喉科杂志, 2015, 15(6): 416-419. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201506015.htm
[9] Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap[J]. Laryngoscope, 2006, 116(10): 1882-1886. doi: 10.1097/01.mlg.0000234933.37779.e4
[10] Tamura R, Toda M, Kohno M, et al. Vascularized middle turbinate flap for the endoscopic endonasal reconstruction of the anterior olfactory groove[J]. Neurosurg Rev, 2016, 39(2): 297-302. doi: 10.1007/s10143-015-0688-1
[11] 章华, 覃艾球, 高可雷, 等. 以筛前动脉为蒂的鼻腔外侧壁黏膜瓣在额窦后壁缺损重建中的应用[J]. 中国耳鼻咽喉颅底外科杂志, 2018, 24(4): 331-335. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY201804007.htm
[12] Fortes FS, Carrau RL, Snyderman CH, et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction[J]. Laryngoscope, 2007, 117(8): 1329-1332. doi: 10.1097/mlg.0b013e318062111f
[13] 徐远志, 薛亚军, 兰津, 等. 多层重建技术在内镜颅底外科手术中的应用[J]. 中华神经外科杂志, 2017, 33(10): 1005-1007.
[14] Clavenna MJ, Turner JH, Chandra RK. Pedicled flaps in endoscopic skull base reconstruction: review of current techniques[J]. Curr Opin Otolaryngol Head Neck Surg, 2015, 23(1): 71-77. doi: 10.1097/MOO.0000000000000115
[15] 李云川, 张罗, 周兵, 等. 鼻内镜下鼻中隔带蒂黏膜瓣修复鼻中隔穿孔和脑脊液鼻漏[J]. 中国耳鼻咽喉头颈外科, 2008, 15(12): 679-681. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT200812009.htm
[16] Havas TE, Lowinger DS. Comparison of functional endonasal sinus surgery with and without partial middle turbinate resection[J]. Ann Otol Rhinol Laryngol, 2000, 109(7): 634-640. doi: 10.1177/000348940010900704
[17] 李艳妮, 李本农, 周建华. 鼻内镜手术并发脑脊液鼻漏2例[J]. 临床耳鼻咽喉头颈外科杂志, 2008, 22(18): 851-853. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH200818014.htm
[18] 唐玲, 徐先发, 王田田, 等. 鼻内镜下带蒂鼻中隔及中鼻甲黏膜瓣行脑脊液鼻漏修补[J]. 中国中西医结合耳鼻咽喉科杂志, 2015, 23(3): 190-194. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH201503011.htm
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