17例脑脊液耳漏的临床诊治分析

目的 本文旨在分析脑脊液耳漏的病因、临床表现、探讨其诊断及治疗方法。方法 回顾性分析自2012年以来南昌大学第一附属医院耳鼻咽喉头颈外科收治的17例脑脊液耳漏患者的临床资料，其中男10例，女7例;成人15例，儿童2例;年龄4~85岁;右耳9例，左耳8例。17例中自发性脑脊液耳漏4例，内耳畸形2例，有头部外伤史6例，有中耳乳突手术史3例，有头颈部恶性肿瘤放疗史2例。其中采用岩骨次全切除术者7例，鼓室探查+前庭封闭术者2例，乳突切开+脑脊液耳漏修补术者7例。结果 1例患者经保守治疗成功，其余16例均一次性手术修补成功;16例患者随访1年以上，1例患者随访3个月以上，均无复发;2例患者术后切口愈合不良，1例为耳道切口，另1例为耳后切口，均经过局部换药治愈。结论 手术是治疗脑脊液耳漏的主要方法。手术成功的关键首先在于准确定位瘘口的部位，其次正确处理封闭瘘口，术后抗炎，降低颅内压对瘘口的修复也十分重要。

Clinical diagnosis and treatment of 17 cases of cerebrospinal fluid otorrhea

Objective The study aimed to analyze the etiology, clinical manifestations, diagnosis and treatment of cerebrospinal fluid otorrhea.Methods Clinical data of 17 patients with cerebrospinal fluid otorrhea were retrospectively analyzed. The 17 patients were admitted to the Department of Otolaryngology head and Neck Surgery, the First Affiliated Hospital of Nanchang University since 2012. They were 15 adults and 2 children, 10 males and 7 females, age range from 4 to 85, 9 cases in right ear and 8 cases in left ear. Among the 17 cases, there were 4 cases of spontaneous cerebrospinal fluid otorrhea, 2 cases of inner ear malformation, 6 cases of head trauma, 3 cases of middle ear mastoid operation, and 2 cases of radiotherapy for head and neck tumor. Among them, subtotal resection of rock bone was performed in 7 cases, tympanum exploration and vestibular closure was performed in 2 cases, mastoid process incision and cerebrospinal fluid otorrhea repair was performed in 7 cases.Results One case accepted conservative treatment, 16 cases were repaired successfully once. The other 16 cases were repaired successfully, and no recurrence was found. There were16 patients followed up for more than 1 year and 1 patient for more than 3 months. Two patients had poor postoperative incision healing, which was cured by local dressing change, including 1 case ear canal incision and 1 case retroauricular incision.Conclusions Surgery was the main treatment of cerebrospinal fluid otorrhea. The key to a successful operation is to locate the fistula accurately. It is also very important for the repair of fistulas to treat the fistulas correctly, to prevent postoperative inflammation and to reduce intracranial pressure.