內視鏡鼻中隔帶蒂皮瓣修補顱底缺損

Endoscopic Skull Base Defect Repair by Pedicled Nasoseptal Flap

季照芸(Chao-Yun Chi) ； 劉永輝(Yong-Hui Liu) ； 蔡易錚(Yih-Jeng Tsai)

《台灣耳鼻喉頭頸外科雜誌》 49卷4期 (2014/12) Pp. 225-229

https://doi.org/10.6286/2014.49.4.225

摘要

背景：有關顱底缺損的修補，因為「內視鏡鼻中隔帶蒂皮瓣修補顱底缺損手術」漸漸廣泛應用而更顯重要。這篇研究中，希望探討使用鼻中隔帶蒂皮瓣修補顱底缺損是否為一有效方式。方法：2012年2月至2013年9月，共有9名顱底缺損的成年病人，在本院接受「內視鏡鼻中隔帶蒂皮瓣修補顱底缺損手術」，術中在掀起鼻中隔帶蒂皮瓣時，會保留蝶顎動脈的分支─後鼻中隔動脈做為他的血管支配，形成帶有血管的莖狀皮辦，並用旋轉方式將其拿來修補顱底缺損。結果：9名接受手術的病人中，平均年齡為51.3歲。其中5名是蝶鞍腫瘤，2名是蝶鞍旁腫瘤，1名是慢性鼻竇炎術後，1名是頭部外傷。術中視野良好，流血量為minimal；術後平均住加護病房時間為1.4天，傷口癒合良好；沒有病人發生術後大量流血、腦脊髓液滲漏、或是腦膜炎等情形。結論：「內視鏡鼻中隔帶蒂皮瓣修補顱底缺損手術」不論是在術中出血還是術後復原，均有良好表現，且未偵測到有重大副作用（如腦脊髓液滲漏、腦膜炎等），也無自體脂肪取出處感染風險，是一項相對安全且值得發展的技術。

關鍵字

內視鏡顱底手術 ； 鼻中隔帶蒂皮瓣 ； 顱底缺損

並列摘要

BACKGROUND: Concerning the repair of skull base defect, the role of ＂Endoscopic Skull Base Defect Repair by Pedicled Nasoseptal Flap＂ was developed gradually. In our study, we would like to discuss the effect of this surgery. MATERIAL AND METHODS: From February 2012 to September 2013, nine adult patients who suffered from skull base defect received ＂Endoscopic Skull Base Defect Repair by Pedicled Nasoseptal Flap＂. A pedicled nasoseptal flap, which was supplied by posterior nasal septal artery (a septal branch of sphenopalatine artery), was rotated to repair skull base defect. RESULTS: In nine patients, the average of age was 51.3 years old. Concerning the etiology, five was sellar tumor, two was parasellar tumor, one was chronic paranasal sinusitis who received functional endoscopic sinus surgery, and the other one had traumatic head injury. During the operation, the operative field was good and the intraoperative bleeding volume was minimal. After the operation, the average duration of intensive care unit (ICU) course was only 1.4 day and the healing of wound was really good. There was no postoperative massive bleeding, cerebrospinal fluid leakage or meningitis. CONCLUSIONS: ＂Endoscopic Skull Base Defect Repair by Pedicled Nasoseptal Flap＂ is a safe and effective surgery. It has minimal intraoperative bleeding volume and good postoperative wound. Besides, there is no major complications, such as cerebrospinal fluid leakage, meningitis, or donor site of auto graft infection. The development of this surgery plays an important role in skull base defect patients.

並列關鍵字

endoscopic skull base surgery ； nasoseptal flap ； skull base defect