经鼻蝶垂体腺瘤切除术出血并发症的原因分析及处理  

Cause analysis and management of hemorrhage in trans-naso-sphenoidal surgery for pituitary adenomas

作　　者：王镛斐[1] 张晓硌[1] 寿雪飞[1] 赵曜[1] 李士其[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中国微侵袭神经外科杂志》2013年第1期21-23,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨经鼻蝶垂体腺瘤切除手术出血并发症的原因及处理方法。方法回顾性研究104例经鼻蝶垂体腺瘤切除手术发生出血并发症病人的临床资料,出血后保守治疗82例,再次手术治疗22例。结果鞍上远隔部出血8例,痊愈3例,长期昏迷1例,死亡4例;颈内动脉出血5例,痊愈4例,死亡1例;瘤腔内出血38例,痊愈25例,视力下降7例,动眼神经麻痹2例,长期昏迷1例,死亡3例;鼻腔出血53例,均获得满意止血。结论出血是经鼻蝶垂体腺瘤手术的常见并发症,大多预后良好,少数严重出血可危及生命;提高显微手术技巧和总结经验教训可减少和避免手术出血并发症。Objective To investigate the causes and management of hemorrhage in trans-naso-sphenoidal surgery for pituitary adenomas. Methods Clinical data of 104 patients with hemorrhage in trans-naso-sphenoidal surgery for pituitary adenomas were analyzed retrospectively. Conservative treatment was performed in 82 patients and reoperation in 22. Results Hemorrhage occurred in distant suprasellar area in 8 patients, including recovery in 3, long-term coma in 1 and death in 4 after treatment. Hemorrhage occurred in internal carotid arteries in 5 patients, including recovery in 4 and death in 1. Hemorrhage occurred in tumor cavities in 38 patients, including recovery in 25, impaired vision in 7, oculomotor paralysis in 2, long-term coma in 1 and death in 3. Hemorrhage occurred in nasal cavity in 53 patients and obtained satisfactory result with hemostasis. Conclusions Hemorrhage is a common complication in trans-naso-sphenoidal surgery for pituitary adenoma. Most patients have good prognosis except for a few serious life-threatening cases. Improving the microsurgical skill and drawing lessons from the past can reduce or avoid the complications of hemorrhage.

关 键 词：垂体肿瘤 手术入路 经鼻蝶 手术中并发症 手术后并发症 出血 

分 类 号：R736.4[医药卫生—肿瘤]