经蝶窦鞍内手术的颅内血管损伤性并发症  

Complications of transsphenoidal surgery for lesions of sellar region: the intracranial vessel injuries

作　　者：倪志立[1] 刘海生[2] 杨占泉[3] 张秋航[1] 

机构地区：[1]首都医科大学宣武医院耳鼻咽喉-头颈外科,100053 [2]清华大学第二附属医院(玉泉医院)神经外科 [3]吉林大学中日联谊医院耳鼻咽喉-头颈外科

出　　处：《神经疾病与精神卫生》2006年第2期113-115,共3页Journal of Neuroscience and Mental Health

摘　　要：目的通过回顾性总结分析经蝶窦鞍内手术中发生的8例血管损伤性并发症病例的临床资料,从而提高对这种少见并发症的认识。方法1964年～2000年间经蝶窦鞍内手术中发生颅内血管损伤性并发症共8例,包括6例蛛网膜下腔出血、1例前海绵间窦出血、1例颈内动脉血栓形成;分析了病人的临床表现、诊断、出血原因,探讨了预防和治疗方法。结果出血原因为肿瘤残体出血2例,损伤鞍膈或蛛网膜出血4例,前海绵间窦过渡发育1例;手术操作刺激引起颈内动脉血栓形成1例;死亡2例,治愈5例,1例术后肢体偏瘫。结论经蝶窦鞍内手术并发颅内血管损伤是一种少见的手术并发症,其发生原因复杂,熟悉鞍区解剖结构和熟练操作技术可明显减少该并发症,一旦发生出血应给予综合性治疗。Objective To improve knowledge of intraeranial vessel injury which is a rare complication of trans-sphenoidal surgery （TSS） for lesions of cerebral region. Methods 8 patients who underwent TSS for lesions of cerebral region occurred intracranial vessel injury during 1964-2001. 6 patients of them occurred subarachnoid hemorrhage, 1 patient occurred anterior intereavernous sinus hemorrhage and 1 thrombus of internal carotid artery. The clinical data of all patients were analyzed and methods of prevention and treatment were discussed. Results The rate of intracranial vessel injuries was 4 percent. The reason for SAH hemorrhage was residues of tumor in 2 patients and damaged cerebra and arachnoid in 4 patients. The hemorrhage of anterior intereavernous sinus was malformation of anterior intereavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. 2 patients died and 5 patients were cured and 1 patient lived with hemiplegia. Conclusion The injury of intraeranial vessels is a rare complication of TSS. The more familiar with anatomy of cerebra and more skillful with TSS, the less the complication occurred.

关 键 词：经蝶手术 蛛网膜下腔出血 颈内动脉 垂体腺瘤 并发症 

分 类 号：R736.4[医药卫生—肿瘤]