摘要
目的探讨经鼻神经内镜手术术中脑脊液漏的评估方法以及相应的颅底重建技术。方法将2012年1月至2015年8月经鼻神经内镜手术的95例患者按术中脑脊液漏等级分为3组,分别采用不同的颅底重建技术,总结分析不同等级的术中脑脊液漏相对应的颅底重建技术。结果术中脑脊液漏等级0级45例,3种颅底重建技术均未见术后脑脊液漏;术中脑脊液漏等级1级21例,术后脑脊液漏发生率比较:粘膜瓣重建18.2%(2/11),联合重建10%(1/10);两者之间的术后脑脊液漏发生率比较无统计学差异。术中脑脊液漏等级2级29例,术后脑脊液漏发生率比较:粘膜瓣重建50%(5/10),联合重建10.5%(2/19);两者之间的术后脑脊液漏发生率比较有统计学差异。结论不同程度的蛛网膜破损应选择不同的颅底重建技术,减少粘膜瓣过度使用带来的并发症和大腿损伤,不仅可以提高术后舒适感,还可以为肿瘤复发后再次手术提供便利。
Objective The intra-operative cerebrospinal fluid leakage after the endoscopic endonasal surgery and the reconstruction method of the skull base were investigated and evaluated. Methods All ninety-five cases that were performed the operation from January 2012 to August 2015 were divided into three groups according to the degrees of intra-operative cerebrospinal fluid leakage, and the different reconstructive approaches were applied, and then the corresponding methods of skull base reconstruction were analyzed with regard to different intra-operative cerebrospinal fluid leakage. Resets In 45 cases whose intra-operative cerebrospinal fluid leakage grade was 0, postoperative cerebrespinal fluid leakage was not found after undergoing three kinds of skull base reconstruction. Among 21 patients with intra-operative cerebrospinal fluid leakage of Grade 1, post-operative cerebrospinal fluid leakage incidence was 18.2% （2/11） in mucosal flap reconstruction group and 10% （1/10） in joint reconstruction group, respectively, which showed no statistical significance. In 29 cases with intra-operatie cerebrospinal fluid leakage of Grade 2, the incidence of pest-operative cerebrospinal fluid leakage went as follows： there were 50% （5/10） of mucosal flap reconstruction and 10. 5% （2/19） of joint reconstruction that demonstrated a significantly statistical difference. Conclusion Different reconstruction approaches should be chosen according to different arachnoid damage degree. Reducing the complication of mucosal flap overuse and thigh injury can increase the comfort of patients and offer the convenience for the resection of recurrent tumors.
作者
陈卫良
陈星
王玉海
杨理坤
李培培
CHEN Weiliang CHEN Xing WANG Yuhai YANG Likun LI Peipei(Department of Neurosurgery, 101st Hospital of PIA, Wuxi 21,1000 Department of Neurosurgery, 515th Hospital of PLA , Jiangyin 214044, China)
出处
《中华神经外科疾病研究杂志》
CAS
2017年第4期334-337,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
神经内镜
脑脊液漏
颅底
重建
Endoscopic endonasal approach
Cerebrospinal fluid leakage
The skull base
Reconstruction
