摘要
目的探讨在鼻内镜下应用带血管蒂鼻中隔黏膜瓣结合自体组织和人工材料的多层修补法修复前颅底硬脑膜缺损。方法回顾性分析应用带血管蒂鼻中隔黏膜瓣在鼻内镜下修复前颅底肿物切除术后硬脑膜缺损患者4例,其中嗅神经母细胞瘤1例,嗅沟脑膜瘤1例,额窦口周围脑膜脑膨出伴脑脊液鼻窦2例。前2例患者为筛骨水平板大小的前颅底缺损,采用阔筋膜、人工硬脑膜和带血管蒂鼻中隔黏膜瓣的多层修补法;后2例患者为单侧额窦口周围较小的前颅底缺损,采用纽扣式阔筋膜-软骨瓣结合带血管蒂鼻中隔黏膜瓣的多层修复。结果所有患者均一次性重建成功。嗅神经母细胞瘤患者术后辅助放射治疗,随访7个月以上无颅底重建组织坏死或塌陷;其余3例患者随访3~7个月,均未发生脑脊液鼻漏及颅内感染。结论鼻内镜下经鼻入路采用带血管蒂鼻中隔黏膜瓣结合自体组织和人工材料的多层修补法是一种可靠的前颅底重建方法。
Objective To introduce the application of vascularized nasoseptal flap and multi-layers method to endoscopic repair of anterior skull base defect. Methods Clinical data of 4 cases with anterior skull base defect repaired with vascularized nasoseptal flap was analyzed retrospectively. One case of olfactory neuroblastoma, one of olfactory meningioma and two of eneephalocele with cerebrospinal rhinorrhea around the frontal sinus were enrolled. In the first two cases, multi-layers reconstruction with fascia lata, artificial duramater and vascularized nasoseptal flap were applied to repair of anterior skull base defects which were as large as horizontal cribriform plate. In the other two cases, button-type fascia lata-cartilage flap and vaseularized nasoseptal flap were used for repair of the small defect around unilateral frontal sinus. Results All defects were successfully reconstructed at the first time. Postoperative radiotherapy was applied to the patient with olfactory neuroblastoma. No sagging or necrosis of the flap was found during the 7 months follow-up. Other cases without postoperative radiotherapy were followed up for 3 to 7 months. Cerebrospinal fluid rhinorrhea or intracranial infection was not observed during the follow-up period in all cases. Conclusion Under nasal endoscope, the multi-layers reconstruction with autologous tissue, artificial material and vascularized nasoseptal flap is a reliable method to repair the defect of anterior skull base.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2014年第6期490-494,共5页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
鼻内镜
前颅底
带血管蒂鼻中隔黏膜瓣
颅底重建
Endoscope
Anterior skull base
Vascularized nasoseptal flap
Reconstruction of skull base
作者简介
魏宏权，男，博士，主任医师，教授。通信作者：魏宏权，Email：hongquanwei@163．com
