鞍区病变经蝶手术中脑脊液漏两种处理策略的比较  

Comparison between Two Different Sellar Reconstruction Methods in the Management of Intraoperative CSF Leakage in Transsphenoidal Microsurgery for Lesions in Sellar Region

作　　者：许志勤[1] 苏长保[1] 

机构地区：[1]中国医学科学院北京协和医院神经外科,100730

出　　处：《医学研究杂志》2013年第6期51-55,共5页Journal of Medical Research

摘　　要：目的比较鞍区病变经蝶手术中脑脊液漏两种不同处理策略的临床效果。方法 A组36例,其中垂体腺瘤31例,垂体Rathke囊肿5例,采用人工脑膜-明胶海绵-生物蛋白胶方法重建鞍底。B组23例,其中垂体腺瘤18例,垂体Rathke囊肿5例,在A组方法的基础上采用手术入路中获得的自体骨质解剖重建鞍底,骨质重建来源分别为:蝶窦腹侧壁骨质18例,骨性鼻中隔4例,蝶窦纵隔骨质1例。结果 A组和B组术后及随诊期均无脑脊液漏病例。B组患者在术后卧床时间、拔除鼻腔填塞物时间、术后住院时间方面均较A组明显缩短,分别缩短了5.31、1.94和3.05天,差异均有极显著性(P值均为0.000,均<0.01)。结论以上两种鞍底重建方法都具有较好的预防鞍区病变经蝶手术中脑脊液漏者术后出现脑脊液漏的效果,但自体骨质鞍底解剖重建方法较传统的人工脑膜-明胶海绵-生物蛋白胶鞍底重建方法更具有优越性。Objective To compare the outcome of two different sellar reconstruction methods in the management of intraoperative CSF leakage in transsphenoidal microsurgery for lesions in sellar region. Methods Group 1 included 36 cases consisting of 31 pituitary adenomas and 5 Rathke cysts, in which the sellar floors were reconstructed with mechanical dura, gelatin foam and fibrin glue. Group 2 included 23 cases consisting of 18 pituitary adenomas and 5 Rathke cysts, in which the sellar floors were reconstructed by the method of group 1 and with additional autogenous bone flap acquired during the transsphenoidal microsurgical approach itself. The sources of autogenous bone flaps for sellar floor reconstruction included paries ventralis of sphenoid sinus in 18 cases, osteoseptum in 4 cases, mediastinum of sphenoid sinus in 1 case. Results There was no postoperative and follow - up CSF leakage in both groups. The patients＇ postoperative lying in bed time, persistent period of nasal packings and postoperative hospitalization for group 2 were reduced by 5.31 , 1.94 and 3.05 days respectively compared to those for group 1 ,and the differences being all extremely significant （ P = 0. 000 for all） between the two groups. Conclusion Both sellar reconstruction methods were effective in the prevention of postoperative CSF leakage for the patients with intraoperative CSF leakage in transsphenoidal microsurgery for lesions in sellar region. But sellar floor reconstruction with additional autogenous bone flap acquired during transsphenoidal microsurgical approach was superior to the traditional sellar floor reconstruction only by mechanical dura, gelatin foam and fibrin glue.

关 键 词：鞍区病变 垂体腺瘤 经蝶手术 脑脊液漏 鞍底重建 

分 类 号：R651.15[医药卫生—外科学]