补救黏膜瓣技术在神经内镜经鼻蝶垂体腺瘤切除术中的应用  

The application of nasoseptal ＂rescue＂ flap technique in endoscopic transsphenoidal pituitary adenoma resection

作　　者：马翔宇[1] 时传君 倪石磊[1] 黄斌[1] 李超[1] 李卫国[1] 陈腾[1] 徐淑军[1] 李新钢[1] Ma Xiangyu;Shi Chuanjun;Ni Shilei;Huang Bin;Li Chao;Li Weiguo;Chen Teng;Xu Shujun;Li Xingang(Department of Neurosurgery, Qilu Hospital of Shandong University, Ji＇nan 250012, China)

机构地区：[1]山东大学齐鲁医院神经外科,山东大学脑科学研究所,济南250012

出　　处：《中华神经外科杂志》2018年第6期568-571,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81201986）;山东省优秀中青年科学家科研奖励基金（BS2013YY018）

摘　　要：目的 初步探讨补救黏膜瓣技术在神经内镜经鼻蝶垂体腺瘤切除术中的应用.方法 回顾性分析山东大学齐鲁医院神经外科2016年1月至2017年3月在神经内镜经鼻蝶垂体腺瘤切除术中应用补救黏膜瓣技术患者的临床资料,共113例.观察鼻腔期及蝶窦期手术耗时及患者的嗅觉障碍、脑脊液漏等相关并发症的发生率.结果 鼻腔期和蝶窦期耗时为15～30 min,平均（24.0±4.5） min;术中27例（23.9％）发生脑脊液漏,其中低流量脑脊液漏24例,20例转为鼻中隔黏膜瓣行鞍底重建;高流量脑脊液漏3例,均转为鼻中隔黏膜瓣行鞍底重建.术后随访时间为3～15个月,平均（8.0±4.3）个月.术后17例（15.0％）嗅觉减退或消失（其中11例为转为鼻中隔黏膜瓣者）;1例（0.9％）鼻出血（为对侧蝶腭动脉分支出血）,1例（0.9％）脑脊液漏,均再次行手术治疗,效果良好.结论 应用补救黏膜瓣技术处理蝶窦开口处鼻中隔黏膜,可以在术中出现鞍膈破裂脑脊液漏的情况下制作鼻中隔黏膜瓣进行鞍底重建,且不增加蝶窦期和鼻腔期的手术时间.Objective To explore the reliability and superiority of nasoseptal ＂rescue＂ flap technique in neuroendoscopic transnasal resection of pituitary adenoma.Methods A retrospective clinical analysis was conducted about 113 cases of endoscopic transsphenoidal pituitary adenoma resection with the application of nasoseptal ＂rescue＂ flap technology in Department of Neurosurgery,Qilu Hospital of Shandong University from January 2016 to March 2017.The reliability and superiority of the technique were evaluated based on the duration of nasal cavity and sphenoid sinus stage,the incidence of post-operative anosmia and cerebrospinal rhinorrhea.Results The duration of nasal and sphenoid sinus stage was 15-30 minutes,averaging 24.0 ± 4.5 minutes.There were 27 （23.9%） cases of intraoperative cerebrospinal fluid leakage including 24 cases of low flow cerebrospinal fluid leak and 3 cases of high flow cerebrospinal fluid leak.Twenty-three cases were converted from nasoseptal ＂rescue＂ flap to nasal septum flap.The patients were followed up for 3-15 months,averaging 8.0 ±4.3 months.There were 17 cases（15.0%） of postoperative olfactory decline or disappearance,1 case（0.9%） of epistaxis and 1 case（0.9%） of cerebrospinal rhinorrhea.Conclusions The application of nasoseptal ＂rescue＂ flap technique could facilitate sellar floor reconstruction in case of intraoperative rupture of diaphragma sellae.There seems to be no increase of the duration of sphenoid sinus and nasal stage.

关 键 词：垂体肿瘤 自然腔道内镜手术 经鼻蝶窦入路 补救黏膜瓣 鼻中隔黏膜瓣 

分 类 号：R736.4[医药卫生—肿瘤]