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目的探索额窦脑脊液鼻漏修补术的进路、修补方法和手术技巧。方法对9例额窦后壁和4例额隐窝后外侧壁脑脊液鼻漏患者进行手术修补,其中首次手术行鼻内镜下修补术12例,联合进路1例;术后观察手术疗效及并发症情况。结果 13例患者中12例一次修补成功,1例二次修补成功。出现并发症2例,其中1例为术后颅内感染,行鼻外引流、额窦填塞术治愈;另1例为阻塞性额窦囊肿,行鼻内镜下额窦开放术治愈。结论经鼻内镜可以成功修补可视的额窦后壁脑脊液鼻漏,但要注意额窦口及漏口大小,防止术后额窦阻塞,诱发阻塞性额窦囊肿、额窦炎和颅内感染;对于额窦内不可视的脑脊液鼻漏和额窦口扩大困难的病例,建议行联合进路修补术。
Objective To explore the approach, repair method and technique of frontal sinus rhinorrhea repair. Methods Nine cases of frontal sinus posterior wall and four cases of frontal crypt with lateral lateral cerebrospinal fluid rhinorrhea were surgically repaired. Among them, 12 cases underwent nasal endoscopic repair in the first operation, and 1 case was treated by combined approach. The operative effect and Complications. Results Of the 13 patients, 12 had a successful repair and 1 had a second repair. Complications occurred in 2 cases, of which 1 case of postoperative intracranial infection, extranasal drainage, frontal sinus stuffing cure; the other 1 case of obstructive frontal sinus cyst, nasal endoscopic sinus surgery under the open. Conclusions Transnasal endoscopy can successfully repair the visible frontal sinus cerebrospinal fluid rhinorrhea, but should pay attention to frontal ostia and leakage size, to prevent postoperative frontal sinus obstruction, induced obstructive frontal sinus cysts, frontal sinusitis and intracranial Infection; for the frontal sinus cerebellar rhinoid invisibility cerebrospinal fluid leakage and frontal sinus enlargement difficult cases, the proposed line of joint repair.