Objective: To evaluate the clinical efficacy of nasal pedicle tissue flap based on nasal blood supply in the reconstruction of nasal skull base defects. Methods: A retrospective analysis was conducted on 138 clinical cases of skull base tumors and cerebrospinal fluid rhinorrhea treated at the Department of Otolaryngology, Head and Neck Surgery at Xiangya Hospital of Central South University from March 2017 to March 2023. A total of 79 males and 59 females were enrolled, aged from 8 to 82 years, with a median age of 51 years, including 108 patients (78.3%) with skull base tumors and 30 patients (21.7%) with cerebrospinal fluid rhinorrhea (and/or meningoencephalocele). During the surgery, 88 cases (63.8%) were repaired with nasal septal mucosal flaps pedicled with the posterior nasal septal artery, 14 cases (10.1%) with mucosal flaps pedicled with the anterior ethmoidal artery on the lateral wall of the nasal cavity, 6 cases (4.3%) with mucosal flaps pedicled with the posterior lateral nasal artery on the lateral wall and nasal floor, 12 cases (8.7%) with mucosal flaps pedicled with the anterior ethmoidal artery and posterior ethmoidal artery, and 18 cases (13.0%) with nasal septal mucosal extension flaps pedicled with the sphenopalatine artery or internal maxillary artery. Patients were followed up for 12 to 72 months postoperatively. Endoscopic examination or skull base enhanced MRI was performed to assess the growth and tumor recurrence in the skull base repair area. The t-test was used for statistical analysis. Results: Among 138 patients, primary repair was successful in 133 patients (96.4%), while 5 patients (3.6%) experienced postoperative cerebrospinal fluid rhinorrhea. These 5 patients all underwent nasal septal mucosal flap repair with the posterior nasal septal artery as the pedicle. Complications included 1 case of mucosal flap necrosis, 1 case of mucosal flap central perforation, and 3 cases of mucosal flap survival peripheral leakage, of which were all successfully treated with a second repair. Conclusion: The use of nasal pedicle mucosal flap based on nasal blood supply is a reliable, safe, and effective technique for repairing skull base defects.
目的： 评估基于鼻腔血供的鼻内带蒂黏膜瓣在鼻颅底缺损重建中的临床应用效果。 方法： 回顾性分析2017年3月至2023年3月，于中南大学湘雅医院耳鼻咽喉头颈外科接受手术治疗的138例颅底肿瘤和脑脊液鼻漏患者的临床资料，其中男性79例，女性59例，年龄8~82岁，中位年龄51岁。涉及颅底肿瘤患者108例（78.3%），脑脊液鼻漏（和/或脑膜脑膨出）患者30例（21.7%）。手术过程中，采用以鼻后中隔动脉为蒂的鼻中隔黏膜瓣修复88例（63.8%），以筛前动脉为蒂的鼻腔外侧壁黏膜瓣修复14例（10.1%），以鼻后外侧动脉为蒂的鼻腔外侧壁及鼻底黏膜瓣修复6例（4.3%），以筛前动脉和筛后动脉为蒂的鼻中隔黏膜瓣修复12例（8.7%），以蝶腭动脉或颌内动脉为蒂的鼻中隔黏膜延长瓣修复18例（13.0%）。术后随访12~72个月，行内镜检查或颅底增强MRI观察颅底修复区域生长及肿瘤复发情况。采用配对t检验进行统计学分析。 结果： 138例患者中，有133例（96.4%）一期修复成功，5例（3.6%）术后出现脑脊液鼻漏。这5例患者均采用以鼻后中隔动脉为蒂的鼻中隔黏膜瓣修复，术后出现黏膜瓣坏死1例、黏膜瓣中心穿孔1例、黏膜瓣存活周边渗漏3例，均再次进行修复手术后治愈。 结论： 采用基于鼻腔血供设计的鼻内带蒂黏膜瓣是一种操作简便、安全性高且效果显著的颅底缺损修复技术。.