【摘要】：目的 研究分析空蝶鞍合并腦脊液鼻漏患者的特有臨床癥狀,發(fā)病機(jī)理,針對其復(fù)發(fā)率高的特點(diǎn)探尋安全有效的治療手段及手術(shù)方法,消除或緩解其臨床癥狀,降低其再次復(fù)發(fā)的幾率,為此類患者的治療提供切實(shí)有效的經(jīng)驗(yàn)和方法,較早的判斷預(yù)后,預(yù)防復(fù)發(fā)。 方法 2006年10月到2011年11月,共治療8例空蝶鞍合并腦脊液鼻漏的患者,7例患者接受全麻腦脊液鼻漏修補(bǔ)手術(shù)。其中,例1、3、5和7行1次鼻內(nèi)鏡下腦脊液鼻漏修補(bǔ)術(shù),修補(bǔ)材料均為自體顳肌和筋膜；例4、8行2次鼻內(nèi)鏡下腦脊液鼻漏修補(bǔ)手術(shù),修補(bǔ)材料為自體顳肌及筋膜；例6行開顱聯(lián)合鼻內(nèi)鏡腦脊液鼻漏修補(bǔ)術(shù)及腦室腹腔分流術(shù),修補(bǔ)材料為異種脫細(xì)胞真皮基質(zhì)；例2行鼻內(nèi)鏡腦脊液鼻漏修補(bǔ)術(shù)復(fù)發(fā),保守治療治愈。例1、2、4、5、6、8患者術(shù)后行腰大池引流1周,臥床3周。例7患者拒絕腰大池引流,手術(shù)治療治愈。 結(jié)果 例1腦脊液鼻漏修補(bǔ)術(shù)后第二天出現(xiàn)腦出血并發(fā)癥,行開顱血腫清除術(shù)后治愈,隨訪2年未復(fù)發(fā)。例2術(shù)后2年復(fù)發(fā),經(jīng)保守治療2周治愈。例3在經(jīng)鼻蝶垂體瘤切除術(shù)后3年出現(xiàn)腦脊液鼻漏,行鼻內(nèi)鏡下腦脊液鼻漏修補(bǔ)術(shù)。例4在鼻內(nèi)鏡修補(bǔ)后3年后復(fù)發(fā),再次行鼻內(nèi)鏡修補(bǔ)手術(shù)。例5、7行鼻內(nèi)鏡腦脊液鼻漏修補(bǔ)術(shù)術(shù)后2年未見復(fù)發(fā)。例6在1年前在外院行經(jīng)鼻蝶腦脊液鼻漏修補(bǔ)術(shù)復(fù)發(fā)后,再次行鼻內(nèi)鏡及開顱聯(lián)合手術(shù)修補(bǔ)并行腦室腹腔分流術(shù)。例8在鼻內(nèi)鏡修補(bǔ)術(shù)后5年復(fù)發(fā)再次行鼻內(nèi)鏡手術(shù)修補(bǔ)。 結(jié)論 1.空蝶鞍綜合征患者的診斷需要依據(jù)癥狀并結(jié)合影像學(xué)檢查,尤其是MRI檢查方可確診。 2.空蝶鞍綜合征合并腦脊液鼻漏的患者臨床少見,治療首選鼻內(nèi)鏡修補(bǔ)術(shù),同時可以行蝶鞍填充術(shù)適當(dāng)抬高鞍底。手術(shù)目的是修補(bǔ)漏口,盡量消除蝶鞍的解剖異常,緩解癥狀。鼻內(nèi)鏡手術(shù)成功率高、并發(fā)癥少。 3.手術(shù)修補(bǔ)后易復(fù)發(fā),復(fù)發(fā)率可達(dá)50%以上。再次復(fù)發(fā)時間可能較長,在數(shù)年甚至數(shù)十年以上。復(fù)發(fā)患者大多伴有原發(fā)性良性高顱壓。 4.復(fù)發(fā)的患者可以再次行鼻內(nèi)鏡下腦脊液鼻漏修補(bǔ)術(shù),鞍膈缺損的可以行開顱鞍膈修補(bǔ)。反復(fù)復(fù)發(fā)的患者可行腦室腹腔分流術(shù)。 5.術(shù)后需長期隨訪,預(yù)防復(fù)發(fā)�？梢员O(jiān)測以下指標(biāo)包括：頭痛癥狀,眼底檢查,垂體激素檢查。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R765.9;R651.1

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