ISSN 1673-3770 CN 37-1437/R
山东大学耳鼻喉眼学报 ›› 2015, Vol. 29 ›› Issue (6): 17-21.doi: 10.6040/j.issn.1673-3770.0.2015.272
张斌, 李峰, 张良文, 杨扬, 朱树干
ZHANG Bin, LI Feng, ZHANG Liangwen, YANG Yang, ZHU Shugan
摘要： 目的 探讨颅脑外伤后顽固性脑脊液耳漏手术治疗的技巧和策略.方法 采用颞下中颅底-乳突后联合入路,对11例颅脑外伤后中颅窝底缺损所致脑脊液耳漏且保守治疗无效的患者施行手术修补.结果 ①无需行乳突探查5例.因乳突为粉碎性骨折,在取下骨瓣前先行钛板固定2例.另外4例乳突粉碎骨折严重,术中将事先收集的颅骨碎屑回植到乳突缺损内,取头最长肌加生物胶加固;②术中发现有颅底广泛骨质缺损6例,脑组织疝入缺损中或乳突黏膜暴露广泛;③修补探查过程发现听骨链完整者3例,缺失2例,部分听小骨(锤骨)缺失2例,术中未探查听骨链者4例.术后随访2~11年,无复发.结论 ①当合并复杂性骨折时,通过幕上幕下联合,经颞下中颅底-乳突后联合入路,无疑是明智的选择,尤其是不稳定骨折累及乳突的患者;②对颅底骨折复杂而听力完全丧失的脑脊液耳漏患者,除了封闭外耳道外,尚需进行鼓室及咽鼓管填塞封闭,以防止假鼻漏的情况发生;③颈内动脉岩段与鼓室及咽鼓管关系密切,脑脊液耳漏修补手术中应避免手术误伤或骨折片意外伤及颈内动脉.
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