肥胖与自发性脑脊液鼻漏的相关性研究

Searching for correlations between spontaneous cerebrospinal fluid rhinorrhea and obesity

摘要:

目的分析肥胖是否是自发性脑脊液鼻漏（CSFR）的独立危险因素，为预防自发性CSFR的发病及降低术后复发率提供依据。方法收集128例CSFR病例，其中男57例，女71例；年龄19~72岁，平均年龄（40.0±3.9）岁。所有患者均在鼻内镜下行脑脊液鼻漏修补术，采用中鼻甲或鼻中隔黏膜、明胶海绵贴补。所有患者入院时常规测量身高和体重，根据身高及体重计算体质指数（BMI），根据引起CSFR的病因将128例患者分为外伤性组、医源性组、肿瘤性组及自发性组。结果自发性组的BMI平均值为33.4 kg/m2，明显高于其他3组(外伤性组BMI平均值23.9 kg/m2,P=0.002;医源性组BMI平均值23.5 kg/m2,P=0.003;肿瘤性组BMI平均值21.3 kg/m2,P=0.000),差异均具有统计学意义。但外伤性组、医源性组与肿瘤性组的BMI经比较，差异无统计学意义（P均>0.05）。术后随访1年，所有患者无任何鼻部、眼部及颅底术后并发症，有5例患者术后出现复发：2例患者术后体重逐渐上升，二次手术修补，并告知患者降低体重，未再出现复发；1例患者自第1次出现复发后，自行进行减肥，未行手术治疗而自愈，随访至今，未再出现复发；2例患者无明显体重增加，二次手术修补后，未再出现复发。结论根据本研究结果，我们认为肥胖只是自发性CSFR的独立危险因素，与其他病因导致的CSFR没有相关性。控制体重是预防自发性CSFR及降低自发性CSFR术后复发率的一种重要举措。

关键词:脑脊液鼻漏|肥胖|自发性

Abstract:

ObjectiveTo analyze whether obesity is an independent risk factor for spontaneous cerebrospinal fluid rhinorrhea(CSFR), and to provide evidence for preventing spontaneous cerebrospinal fluid rhinorrhea and reducing postoperative recurrence rate.MethodsA total of 128 CSFR cases were collected, including 57 males and 71 females. Their age ranged from 19 to 72 years with an average age of (40.0±3.9) years. All patients underwent CSFR repairment for middle turbinate or nasal septum mucosa supplemented with gelatin sponge by nasal endoscopy. Height and weight were routinely measured at the time of admission, and body mass index(BMI) was calculated based on height and weight. According to the cause of CSFR, 128 patients were divided into traumatic group, iatrogenic group, tumor group and spontaneous group.ResultsThe average BMI of the spontaneous group was 33.4 kg/m2, which was significantly higher than that of the other three groups(the average BMI of the traumatic group was 23.9 kg/m2,P=0.002; the average BMI of iatrogenic group was 23.5 kg/m2,P=0.003; the average BMI of the oncology group was 21.3 kg/m2,P=0.000). However, there was no significant difference (all P＞0.05) in BMI among the three groups(traumatic group, iatrogenic group and tumor group). All patients had no postoperative complications of nose, eye and skull base after 1 year of postoperative followup. And 5 patients had recurrence after operation :2 patients had gradually increased weight after operation and a secondary operation repair, who were informed the patient to lose weight and no recurrence;1 patient had lost weight on his own since the first recurrence without a secondary surgical treatment and no recurrence during a followup; 2 patients had no significant weight gain and no recurrence by secondary repairment.ConclusionsAccording to the results of this study, we thought that obesity was only an independent risk factor for spontaneous CSFR, and not associated with CSFR of other causes. Weight control is an important measure to prevent spontaneous CSFR, which will reduce the recurrent rate of postoperative spontaneous CSFR.

Key words:Cerebrospinal fluid rhinorrhea|Obesity|Spontaneous