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目的探讨外伤性脑脊液鼻漏的手术治疗效果。方法回顾性分析27例行手术治疗的外伤性脑脊液鼻漏病例。术前根据影像学定位行冠状切口开颅入路21例,眉弓切口眶上锁孔入路6例。术前、术后行积极内科治疗。结果21例行开颅手术的病人中19例(90.5%)痊愈,1例症状缓解后经内科治疗痊愈,1例因反复颅内感染而死亡;术后平均住院13.9d。6例行锁孔手术的病人中5例(83.3%)痊愈;1例缓解后经内科治疗痊愈;术后平均住院8.7d。术后随访3个月,均无复发。两种术式在疗效上无明显差别,但术后平均住院时间有显著差异。结论采取冠状切口开颅入路和眉弓切口眶上锁孔入路治疗外伤性脑脊液鼻漏疗效满意。对于漏口位置明确、单侧单一漏口且漏口较小者,眶上锁孔入路能在治愈鼻漏的同时获得更小的手术创伤,住院时间更短。
Objective To investigate the surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Methods A retrospective analysis of 27 cases of surgical treatment of traumatic cerebrospinal fluid rhinorrhea cases. 21 cases underwent craniotomy under the guidance of imaging and 6 cases underwent supraorbital keyhole incision under the eyebrow. Preoperative and postoperative positive medical treatment. Results Of the 21 patients who underwent craniotomy, 19 (90.5%) recovered. One patient recovered after medical treatment and one patient died of recurrent intracranial infection. The average postoperative hospital stay was 13.9 days. Among the 6 patients who underwent keyhole surgery, 5 patients (83.3%) recovered, one patient recovered after medical treatment and the average postoperative hospitalization was 8.7 days. All patients were followed up for 3 months without recurrence. No significant difference in the efficacy of the two surgical procedures, but the average postoperative hospital stay were significantly different. Conclusion Coronary incision craniotomy and eyebrow incision supraorbital keyhole approach for the treatment of traumatic cerebrospinal fluid rhinorrhea is effective. For the clear location of the leak, unilateral single leak and leakage is smaller, supraorbital keyhole approach can cure nasal leakage while getting smaller surgical trauma, hospitalization shorter.