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目的:分析成人和儿童自发性脑脊液耳漏在临床表现、CT影像、耳漏部位及手术操作等方面的差异性。方法:6例自发性脑脊液耳漏患者中,成人4例,儿童2例。均采用经乳突入路的手术方式。4例成人患者中,2例漏口位置在乳突盖、1例在鼓室盖、1例在窦脑膜角,内耳结构未见异常,骨质缺损部位采用自体游离肌肉、筋膜、耳脑胶封堵;2例儿童缺损部位在前庭窗且伴有内耳发育异常,瘘口位置采用游离肌肉加筋膜加肌肉分层哑铃型填塞。结果:5例患者均一次手术成功,未再复发;另外1例成人患者左耳术后1年复发、第2次术后2年复发、第3次术后1年半未复发,右耳术后3年未复发。结论:成人和儿童自发性脑脊液耳漏临床表现不同,术前颞骨高分辨率CT对于漏口部位的判断非常重要,特别是成人患者应该明确脑脊液耳漏的位置及漏口数量,对于手术方式的选择具有重要价值和意义。
OBJECTIVE: To analyze the differences of clinical manifestations, CT images, ear leaks and surgical procedures between spontaneous cerebrospinal fluid leakage in adults and children. Methods: Among 6 patients with spontaneous cerebrospinal fluid leakage, 4 were adults and 2 were children. All the way through the mastoid approach. Of the 4 adult patients, 2 had leakage at the papillae, 1 at the tympanic cap, 1 at the sinonasal angle, and no abnormalities in the structure of the inner ear. The site of bone defects was autologous muscle, fascia, 2 cases of child defect in the vestibular window accompanied by dysplasia of the inner ear, fistula position with free muscle plus fascia muscle stratified dumbbell-shaped packing. Results: All the 5 patients were operated successfully without recurrence. The other 1 patient had recurrence 1 year after operation in the left ear, 2 years after the second operation, 1 year and 1 year after the third operation, No recurrence after 3 years. Conclusion: The clinical manifestations of spontaneous cerebrospinal fluid leakage in adults and children are different. The preoperative temporal bone high resolution CT is very important for the judgment of the leak site. In particular, adult patients should know the location of cerebrospinal fluid otorrhea and the number of leaks. The choice of surgical procedure has Important value and meaning.