经鼻蝶入路垂体手术中及手术后脑脊液漏的防治  

Prevention and treatment of intraoperative and postoperative CSF leakage in the patients with pituitary lesions undergoing transsphenoidal surgery

作　　者：毛立武[1] 陈治标[1] 王军民[1] 许州[1] 符常涛[1] 聂晓奇[1] 

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2013年第3期132-134,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的 研究经鼻蝶入路垂体手术中及手术后脑脊液漏的发生率、影响因素,并探讨术中及术后脑脊液漏的防治方法。方法 回顾性分析武汉大学人民医院神经外科2006年5月至2011年12月行经鼻蝶入路垂体手术276例患者(其中垂体腺瘤270例,垂体脓肿3例,粘液囊肿2例,垂体转移瘤1例)的临床资料,并对术中、术后脑脊液漏的防治进行探讨。结果 108例(39.1%)术中发生脑脊液漏,14例(5.1%)术后出现脑脊液漏(1例合并脑膜炎)。14例术后脑脊液漏患者中,8例平卧5～7d后脑脊液漏消失;6例经蝶窦再探查,重新封闭后3例治愈,1例行腰椎穿刺置管脑脊液引流5d后治愈,2例引流1周症状无改善,经内镜修补漏口后脑脊液漏停止。未发现患者年龄、性别、肿瘤生长方式、肿瘤类型、手术放疗史与术后脑脊液漏之间有相关性。结论 术者经验是减少术中脑脊液漏的重要因素,积极重建封闭鞍底是预防术后脑脊液漏的关键,及时重新蝶窦探查,封闭鞍底,选择性腰椎置管引流,必要时经内镜等措施修补漏口,可有效治疗术后脑脊液漏。Objective To explore the methods to prevent and treat cerebrospinal fluid （CSF） leakage in the patients with pituitary lesions undergoing tgranssphenoidal surgery. Methods The clinical data of 276 patients with pituitary lesions （including 270 cases of pituitary adenomas, 3 cases of pituitary abscesse, 2 cases of mucous cyst and 1 case of pituitary metastatic cancers）, who underwent transsphenoidal surgery in Renmin Hospital from May, 2006, to December, 2011, were analyzed respectively. Results The intraoperative CSF leakage occurred in 108 patients （39.1%） and the postoperative CSF leakage in 14 patients （5.1%）, among whom 1 patient had meningitis. The CSF leakage disappeared from 5 to 7 days after the supination in 8 patients with postoperative CSF leakage. Transsphenoidal surgery was performed again to treat the CSF leakage in 6 patients with postoperative CSF leakage, of whom, 3 were cured, 1 were cured 5 days after lumbar drainage of CSF and 2 were cured by endoscope-assisted repair. Conclusions Surgeon＇ s experience is an important factor to reduce intraoperative CSF leakage during the transsphenoidal surgery. Rebuilding and closing sellar base are effective methods to prevent and treat the CSF leakage. The lumbar drainage of CSF, transsphenoidal repair and endoscope-assisted repair are important methods to treat the postoperative CSF leakage in the patients with pituitary lesions undergoing the transsphenoidal surgery.

关 键 词：经鼻蝶窦入路 垂体腺瘤 脑脊液漏 

分 类 号：R736.4[医药卫生—肿瘤] R765.24[医药卫生—临床医学]