摘要
目的：探讨利用鼻内自体材料在内镜下重建鼻颅底缺损治疗脑脊液鼻漏的方法及可行性。方法：内镜下应用鼻内自体组织对96例患者进行颅底缺损重建治疗脑脊液鼻漏。根据颅底骨缺损的部位、大小决定修复的材料和方法．18例缺损直径〈0．5cm，取游离中鼻甲黏骨膜外置法重建；35例缺损位于筛顶和筛板，缺损直径0．5～〈1．0cm．应用带蒂中鼻甲外置法重建；12例缺损位于蝶鞍斜坡，缺损直径0．5～〈1．0cm，应用带蒂鼻中隔黏骨膜瓣外置法修复；19例缺损直径1．0～〈1．5cm，应用游离鼻中隔软骨-黏骨膜瓣修复；7例缺损位于筛顶和筛板，缺损直径1．5～2．5cm，应用筛骨垂直板加带蒂中鼻甲重建；5例缺损位于蝶鞍斜坡，缺损直径1．5～2．5cm，则应用筛骨垂直板加带蒂鼻中隔黏骨膜瓣重建颅底。结果：随访6个月～6年，2例患者分别于术后1年和2年再次出现脑脊液鼻漏，1例经保守治疗后脑脊液漏停止，1例患者经再次手术治愈；3例患者于术后出现短暂性脑脊液漏，未经特殊处理自愈；其余患者未再出现脑脊液漏。结论：应用鼻内自体材料在内镜下进行颅底重建治疗脑脊液鼻漏具有取材方便、手术成功率高等优点；不同大小和不同部位的颅底缺损宜选择不同的鼻内自体材料进行重建。
Objective：To explore the methods and feasibility of the transnasal endoscopic reconstruction of the nasal-skull base defect to manage the eerebrospinal fluid leaks using intranasal autologous grafts. Method：Ninety six nasal-skull base defect patients with cerebrospinal fluid leaks were managed under endoscope with intranasal autologous materials. The repair materials and methods for the management of the cerebrospinal fluid leaks were tailored based on the different location and size of nasal-skull base defect. Eighteen cases with nasal-skull base de fects less than 0.5 cm in diameter were repaired by an overlay technique using free mucoperiosteal graft from the middle turbinate. Thirty five patients with defects in the ethmoid roof and ethmoid plate ranging in size from 0.5 to 1, 0 cm in diameter were repaired by an overlay technique using a pedicled middle turbinate flaps. Twelve cases with defects in the sellar clivus ranging in size from 0.5 to 1.0 cm in diameter were repaired by an overlay technique using a pedicled septal mucoperiosteal grafts. Nineteen cases with a diameter of 1.0 to 1.5 cm defects were repaired using free septal cartilage and mucoperiosteal grafts. Seven cases with defects in the ethmoid roof and ethmoid plate ranging from 1.5 to 2.5 cm in diameter were repaired using a pedicled middle turbinate and ethmoid plate flaps. Five sellar clival defect cases ranging from 1.5 to 2.5 cm in diameter were repaired using ethmoid plate and pedicled septal mucoperiosteal flaps. Result：Six months to 6 years＇ follow up indicated that two patient developed postoperative cerebrospinal fluid leaks one year and two years after operation, respectively. One was successfully managed by conservative treatment. The other was successfully repaired by second surgery. Three patients developed transient postoperative cerebrospinal fluid leak that was spontaneous recovered without special treat ment. No other new postoperative cerebrospinal fluid leaks occurred. Conclusion： We concluded that tra
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2008年第17期769-771,共3页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
颅底重建
脑脊液鼻漏
鼻内镜手术
鼻内自体材料
Nasal skull base reconstruction
Cerebrospinal fluid leaks
Transnasal endoscopic surgery
Intranasal autologous grafts
