鼻内镜及高分辨CT在脑脊液鼻漏诊治中的应用研究(1)
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【摘要】 目的 探讨经鼻内镜下脑脊液鼻漏修补术中准确寻找漏口及术后综合治疗的相关问题。方法 收集我科2005~2009年经鼻内镜修补脑脊液鼻漏患者28例的临床资料,外伤后脑脊液鼻漏20例,特发性脑脊液鼻漏8例,通过螺旋薄层CT及鼻内镜下漏口处黏膜的特点确定漏口的位置,采用大腿阔筋膜作为修补材料。结果 所有患者随访3个月以上,28例患者中,初次手术者27例,1例为再次手术者。漏口单独位于筛顶的11例,筛板的6例,蝶窦的6例,额窦开口处及额窦的4例,筛蝶窦均有漏口的1例,均一次性成功治愈。结论 螺旋薄层CT及鼻内镜下漏口处苍白色水肿黏膜对确定漏口至关重要,术后采用综合治疗有利于保证漏口的修补成功。
【关键词】 鼻内镜手术;高分辨CT;水肿黏膜;脑脊液鼻漏
The application nasal endoscopy and high resolution CT in the diagnosis and treatment of cerebrospinal fluid rhinorrhea
LI Ji-zhou, SONG Jian-jing, WANG Shao-bo,et al.
Department of Otolaryngology-Head and Neck’The Hospital of Weihai city,Shandong 264200,China
【Abstract】 Objective To evaluate the endoscopic repair of cerebrospinal fluid rhinorrhea accurately and combined therapy after operation. Methods Collected our department endoscopic repair of cerebrospinal fluid rhinorrhea clinical data of 28 patients from 2005 to 2009, with post-traumatic cerebrospinal fluid rhinorrhea in 20 cases, idiopathic in 8 cases of cerebrospinal fluid rhinorrhea. By thin-layer spiral CT and endoscopic mucosal leakage characteristics of the mouth to determine the location of mouth leakage, using thigh fascia lata as a repair material. Results All 28 patients were followed up for more than 3 months, the initial surgery in 27 cases, 1 case was re-surgery. The sites of cerebrospinal fluid is located in theEthmoid roof wall of 11 cases, 6 cases of cribriform plate, sphenoid sinus in 6 cases,frontal sinus openings in 4 cases, 1 case of Ethmoid and sphenoid sinus. All patients were successfully treated once.Conclusion Thin spiral CT and endoscopic drain mouth pale edema mouth mucosa is essential for determining the leakage. The combined treatment after operation will help ensure a successful surgical repair.
【Key words】Endoscopic surgery; High-resolution CT; Mucosal edema; Cerebrospinal fluid rhinorrhea
DOI:10.3760/cma.j.issn 1673-8799.2010.11.40
作者单位:264200山东省威海市立医院耳鼻咽喉头颈外科
脑脊液鼻漏是指颅骨-脑膜的缺损,蛛网膜下腔与鼻腔或鼻窦形成沟通,脑脊液经上述缺损部位流入鼻腔,随着社会的发展,交通及建筑事故的增多,鼻内镜下处理鼻腔、鼻窦及颅底病变手术的开展以及诊断技术的创新,脑脊液鼻漏在临床疾病中呈不断增多的趋势。鼻内镜下处理脑脊液鼻漏已经成为耳鼻咽喉头颈外科的重要研究内容之一,并且已得到神经外科的认可。鼻内镜下脑脊液鼻漏修补术旨在提供合适的移植创面及给予适当的压力促进创面生长愈合,要想在术中修复的密不透水几乎是不可能的。我科自2005~2009年经鼻内镜修补脑脊液鼻漏患者28例,现总结报告如下。
1 资料与方法
1.1 一般资料 经鼻内镜修补脑脊液鼻漏28例,男20例,女8例,年龄18～62岁,平均32岁。外伤后脑脊液鼻漏20例,其中医源性脑脊液鼻漏8例(2例为鼻内镜手术中发生,6例为迟发型脑脊液鼻漏);特发性脑脊液鼻漏8例,其中2例有颅内感染的反复发病史;鼻腔分泌物常规检测,葡萄糖含量均超过1 ......
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