内镜经鼻脂肪压塞技术在儿童脑脊液鼻漏修补术中的应用
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1.国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科 100045;2.通信作者:葛文彤,Email:gwt@bch.com.cn

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“Bath- plug” technique for the transnasal endoscopic repair of CSF leaks in children
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Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health

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    目的 探讨内镜经鼻脂肪压塞技术在儿童脑脊液鼻漏修补术中的安全性和有效性。方法 回顾性分析2016年9月至2019年9月北京儿童医院耳鼻咽喉头颈外科收治的16例脑脊液鼻漏患儿的临床资料。其中男10例,女6例,年龄5~123月龄,中位年龄57.5个月。全部病例常规进行鼻窦薄层CT及MRI检查,并进行了全身麻醉下经鼻内镜脂肪压塞法脑脊液鼻漏修补术。术后定期随访,对手术效果及并发症进行评估。对所有患儿的人口学特点、症状、体征、颅底漏口位置及面积、治疗及预后情况等进行归纳总结。结果 16例患儿中,外伤性脑脊液鼻漏7例,先天性脑脊液鼻漏9例。单纯性脑脊液鼻漏2例,合并基底型脑膜脑膨出14例。颅底漏口分别为左侧筛板6例,右侧筛板4例,左侧筛顶2例,右侧筛顶1例,左侧额窦后壁2例,右侧蝶窦顶壁1例。漏口最大直径1~4mm 4例,5~10mm 7例,11~20mm 5例。全部病例中,15例手术获得一次性成功,仅1例额窦后壁外伤性脑脊液漏内镜手术修补失败,改由神经外科行开颅修补术。全部病例随访24~60个月,中位随访时间32.5个月,均未复发或出现并发症。结论 内镜经鼻脂肪压塞法儿童脑脊液鼻漏修补术是一种安全、有效的手术方式,具有操作简便、创伤小、并发症少等优点。

    Abstract:

    Objective To assess the outcomes associated with the fat bath-plug to endoscopically repair cerebrospinal fluid (CSF) leaks in children. Methods All patients, who underwent endoscopic repair of CSF leaks utilizing abdominal free fat from September 2016 to September 2019, were included for retrospective chart review. There were 10 boys and 6 girls, aged from 5 to 123 months with a median age of 57.5 months. Radiological workups and endoscopic procedures with a fat bath-plug were performed for all patients. Patient characteristics, initial presentation, locations and sizes of CSF leaks, surgical procedures, recurrences, complications at both donor and recipient graft sites were evaluated. Results: Of all patients, 7 suffered from traumatic CSF leaks and 9 congenital CSF leaks. Fourteen patients presented with CSF leaks and encephaloceles. The sites of skull base defects included cribriform plate (n=10), ethmoid roof (n=3), posterior wall of frontal sinus (n=2), and sphenoid roof (n=1). The maximum diameter of skull base defects included 1~4mm (n=4),5~10mm (n=7),and 11~20mm (n=5). Of all patients, 15 underwent endoscopic procedures successfully, while one patient required the neurosurgical service to repair a large posterior wall defect of frontal sinus from a car accident via open transcranial approaches. All patients had favorable clinical outcomes without any recurrences or complications during a follow-up of 24~60 months. Conclusions With easy procedure, less injuries and complications, the fat bath-plug technique is safe and effective for the endoscopic repair of both congenital and traumatic CSF leaks in children.

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  • 收稿日期:2021-10-23
  • 最后修改日期:2021-12-07
  • 录用日期:2021-12-09
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