经颅垂体瘤手术中的鞍隔切口及缺损的一期修复重建  

Repair and Reconstruction of Diaphragmatic Defect During Transcranial Pituitary Adenoma Surgery

作　　者：周培志[1] 程书文[1] 杨章超[1] 马卫朝[1] 董伟[1] 彭里磊[1] 姜曙[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《四川大学学报（医学版）》2010年第4期728-730,747,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的探讨在经颅垂体瘤手术中使用钛夹、人工脑膜等材料进行的修复切口及缺损鞍隔重建价值及意义。方法对我院38例经颅垂体瘤手术中进行鞍隔缺损程度分级并进行鞍隔修复重建,切除肿瘤后使用钛夹、人工脑膜、医用耳脑胶对鞍隔进行一期修复、重建,对照组为未进行鞍隔重建的74例患者,比较两组患者的围手术期及远期并发症和预后情况。结果随访14~46个月,鞍隔重建组中,1例患者术后3 h CT显示鞍区未压迫视神经的小血肿,均未发生脑脊液漏、颅内感染、空蝶鞍综合征及其他并发症。鞍隔未重建组中,1例术后1 h因鞍区出血出现进行性视力下降及意识障碍并再次开颅手术,空蝶鞍发生率及需二期经蝶手术患者的脑脊液漏、颅内感染的发生率高于鞍隔重建组(P<0.05),但两组的尿崩症发生率及垂体功能、视力恢复情况差异无统计学意义(P>0.05)。结论经颅垂体瘤手术中依据鞍区的解剖生理状态进行鞍隔修复重建非常必要,钛夹、人工脑膜、耳脑胶在其中具有新的应用价值,可显著减少术后因鞍区出血需再次手术、空蝶鞍、二期经蝶手术脑脊液漏和颅内感染的发生率,此技术具有推广价值。Objective To investigate the application value of titanium-clip and artificial menigeal in the sella diaphragm repair and reconstruction during transcranial pituitary adenoma surgery.Methods Thirty eight patients undergoing transcranial pituitary adenoma surgery received sella diaphragmatic defect repair and reconstruction after the removal of tumor,intraoperative diaphragmatic defect was classified as three grades,titanium-clip,artificial menigeal and EC glue were used for the sella diaphragmatic repair and reconstruction.The short-term and long-term complications were compared with those in the control group which contains 74 patients without diaphragmatic reconstruction.Results As 14 to 46 months’ follow-up in the diaphragmatic reconstruction group,there were no leakage of cerebrospinal fluid(CSF),infections,empty sella syndrome(ESS),optic nerve damage,and any other severe complications was found.Only one inter-sella hemorrhage without optic nerve damage was found 3 hours after surgery by CT scan.In the group without diaphragmatic reconstruction,more secondary empty sella,cerebrospinal fluid rhinorrhea and intra-cranial infection were found after the following transsphenoidal surgery(P0.05).Conclsuion It is important to repair the sellae diaphragm defect during transcranial pituitary adenoma surgery,which could reduce short-term and long-term complication.

关 键 词：垂体肿瘤 脑脊液鼻漏 空蝶鞍综合征 修复外科手术 

分 类 号：R736.4[医药卫生—肿瘤]