内镜下颅底重建的动物实验研究

目的 研究鼻中隔带蒂黏膜瓣修复颅底缺损及放疗对愈后的影响。方法 对10例新鲜白兔尸体的鼻中隔黏膜血供行解剖学研究。将20只健康新西兰大白兔作为实验动物，建立颅底缺损-脑脊液鼻漏模型并利用鼻中隔带蒂黏膜瓣修复颅底缺损，术后7、10d在鼻内镜下观察切口愈合及脑脊液鼻漏情况，术后21d随机抽出10只接受手术治疗的兔子作为实验组行颅脑放疗，其余10只作为对照组，放疗后1、14d实验组和对照组分别于鼻内镜下观察修复区域。 结果7例鼻中隔黏膜瓣血供由鼻中隔后下端进入，2例血供由近鼻中隔后端约1cm处进入，1例未见明显血管分布，成功构建了颅底缺损-脑脊液鼻漏模型并成功实施鼻中隔带蒂黏膜瓣修复颅底缺损手术20例，均全部存活，切口愈合良好，无脑脊液鼻漏，无组织膨出及神经功能缺失等并发症；10只接受术后放疗的兔子及对照组的10只兔子均全部存活，放疗组兔子切口愈合较慢。结论 鼻中隔带蒂黏膜瓣修复颅底缺损的动物实验模型设计可行，放疗对带蒂鼻中隔黏膜瓣有延迟愈合的影响。

Endoscopic reconstruction of skull base in animal experiments

Objective To explore the impaction and significance of radiation therapy on repair of skull base defect with nasal septum mucosa flap with pedicle in rabbit models. Methods Ten fresh white rabbit bodies served for the anatomy research of blood supply of nasal septum mucosa flap. Twenty New Zealand white rabbits were induced into models of skull base defect and cerebrospinal fluid rhinorrhea. Nasal septum mucosa flap with pedicle was employed to reconstruct the defect and repair the leakage. Seven days and 10 days after the operation, wound healing and leakage were observed by nasal endoscopy. Twenty-one days after the operation, 10 rabbits which accepted the surgical treatment as the experimental group were randomly drew to get radiation therapy, the other 10 as the control group. One day and 14 days after the radiation therapy, repair area of the experiment and the control groups were respectively observed by nasal endoscopy. Results Seven blood supplies of the nasal septum mucosa flap come from behind and below the nasal septum, 2 blood supplies come from behind the nasal septum 1cm away, and 1 did not show obvious blood supply. Twenty rabbits models of skull base defect and cerebrospinal fluid rhinorrhea and the nasal septum mucosa flap with pedicle was employed to reconstruct the defect and repair the leakage were successfully established and survived without any complication as continuous rhinorrhea of cerebrospinal fluid, local tissue eminence and neurological function defect.Ten rabbits of the experiment group which accepted radiation therapy and 10 rabbits of the control group were all survived, but the speed of wound healing of the rabbits of the experiment group was fairly slower. Conclusion Repair of skull base defect with the nasal septum mucosa flap with pedicle in rabbit models is feasible, and radiation therapy can delay the speed of healing of the nasal septum mucosa flap with pedicle.