空蝶鞍合并脑脊液鼻漏患者的特点及治疗

发布时间：2018-07-16 10:10

【摘要】：目的研究分析空蝶鞍合并脑脊液鼻漏患者的特有临床症状,发病机理,针对其复发率高的特点探寻安全有效的治疗手段及手术方法,消除或缓解其临床症状,降低其再次复发的几率,为此类患者的治疗提供切实有效的经验和方法,较早的判断预后,预防复发。方法 2006年10月到2011年11月,共治疗8例空蝶鞍合并脑脊液鼻漏的患者,7例患者接受全麻脑脊液鼻漏修补手术。其中,例1、3、5和7行1次鼻内镜下脑脊液鼻漏修补术,修补材料均为自体颞肌和筋膜；例4、8行2次鼻内镜下脑脊液鼻漏修补手术,修补材料为自体颞肌及筋膜；例6行开颅联合鼻内镜脑脊液鼻漏修补术及脑室腹腔分流术,修补材料为异种脱细胞真皮基质；例2行鼻内镜脑脊液鼻漏修补术复发,保守治疗治愈。例1、2、4、5、6、8患者术后行腰大池引流1周,卧床3周。例7患者拒绝腰大池引流,手术治疗治愈。结果例1脑脊液鼻漏修补术后第二天出现脑出血并发症,行开颅血肿清除术后治愈,随访2年未复发。例2术后2年复发,经保守治疗2周治愈。例3在经鼻蝶垂体瘤切除术后3年出现脑脊液鼻漏,行鼻内镜下脑脊液鼻漏修补术。例4在鼻内镜修补后3年后复发,再次行鼻内镜修补手术。例5、7行鼻内镜脑脊液鼻漏修补术术后2年未见复发。例6在1年前在外院行经鼻蝶脑脊液鼻漏修补术复发后,再次行鼻内镜及开颅联合手术修补并行脑室腹腔分流术。例8在鼻内镜修补术后5年复发再次行鼻内镜手术修补。结论 1.空蝶鞍综合征患者的诊断需要依据症状并结合影像学检查,尤其是MRI检查方可确诊。 2.空蝶鞍综合征合并脑脊液鼻漏的患者临床少见,治疗首选鼻内镜修补术,同时可以行蝶鞍填充术适当抬高鞍底。手术目的是修补漏口,尽量消除蝶鞍的解剖异常,缓解症状。鼻内镜手术成功率高、并发症少。 3.手术修补后易复发,复发率可达50%以上。再次复发时间可能较长,在数年甚至数十年以上。复发患者大多伴有原发性良性高颅压。 4.复发的患者可以再次行鼻内镜下脑脊液鼻漏修补术,鞍膈缺损的可以行开颅鞍膈修补。反复复发的患者可行脑室腹腔分流术。 5.术后需长期随访,预防复发。可以监测以下指标包括：头痛症状,眼底检查,垂体激素检查。
[Abstract]:To reduce the probability of recurrence, to provide effective experience and method for the treatment of this kind of patients, to judge the prognosis earlier and to prevent recurrence. Methods from October 2006 to November 2011, 7 patients with cerebrospinal fluid rhinorrhea were treated with general anesthesia and cerebrospinal fluid rhinorrhea repair. Case 6 underwent craniotomy combined with endoscopic cerebrospinal fluid rhinorrhaphy and ventriculoperitoneal shunt with xenogeneic acellular dermal matrix and case 2 with endoscopic cerebrospinal fluid rhinorhinorrhaphy and cured by conservative treatment. Cases (1, 2, 4, 5, 6) were treated with lumbar cistern drainage for 1 week and bed rest for 3 weeks. Case 7 refused lumbar cistern drainage and was cured by operation. Results in case 1, the complications of intracerebral hemorrhage occurred on the second day after cerebrospinal rhinorhinorrhaphy, and were cured after craniotomy and hematoma removal, and no recurrence occurred after 2 years follow-up. Case 2 recurred 2 years after operation and was cured by conservative treatment for 2 weeks. Case 3 had cerebrospinal fluid rhinorrhea 3 years after transsphenoidal pituitary adenoma resection. Case 4 recurred 3 years after endoscopic repair and underwent endoscopic repair again. No recurrence was found 2 years after endoscopic cerebrospinal fluid rhinorrhea repair in 7 cases. Case 8 underwent endoscopic surgery again after 5 years of endoscopic sinus repair. Conclusion 1. The diagnosis of empty Sella syndrome needs to be based on symptoms and imaging examination, especially MRI. Patients with empty Sella syndrome complicated with cerebrospinal fluid rhinorrhea are rare. The purpose of the operation is to repair the leak, to eliminate the anatomic abnormality of Sella turcica and to relieve the symptoms as far as possible. The success rate of endoscopic sinus surgery was high and the complications were less. 3. 3%. The recurrence rate was more than 50%. Recurrence may take a long time, years or even decades or more. Recurrent patients were mostly associated with primary benign intracranial hypertension. 4. 4. Recurrent patients can be repaired with cerebrospinal fluid rhinorrhea under nasal endoscope, and patients with Sellar diaphragm defect can be repaired by craniotomy. Repeated recurrence of patients feasible ventricular peritoneal shunt. 5. Long-term follow-up was needed to prevent recurrence. The following indicators can be monitored: headache symptoms, fundus examinations, and pituitary hormone tests.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R765.9;R651.1

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