经鼻蝶垂体病变切除手术并发嗅觉损害的原因与预防措施分析  

Causes and precaution procedures for olfactory dysfunction after transsphenoidal surgery for pituitary lesions

作　　者：冯子泽 伍益[1] 李智斌[1] 董家军[1] 古机泳[1] 彭逸龙[1] 陈志勇[2] Feng Zize;Wu Yi;Li Zhibin;Dong Jiajun;Gu Jiyong;Peng Yilong;Chen Zhiyong(Department of Neurosurgery,Jiatigmen Central Hospital,Jiangmen 529000,China;Department of Neurosurgery,First Affiliated Hospital of Jinan University,Guangzhou 510630,China)

机构地区：[1]广东省江门市中心医院神经外科,529000 [2]暨南大学附属第一医院神经外科,广州510630

出　　处：《中华神经医学杂志》2020年第3期277-280,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨经鼻蝶垂体病变切除手术并发嗅觉损害的原因与预防措施。方法江门市中心医院神经外科自2016年11月至2018年5月采用经鼻蝶切除手术治疗垂体病变患者72例,其中采用显微镜下经鼻蝶垂体病变切除手术27例,采用内镜下经鼻蝶垂体病变切除手术45例。术后1个月、6个月评估术后嗅觉障碍患者的嗅觉功能。术后3?6个月使用鼻内镜检査患者双侧鼻腔情况。分析术中操作与嗅觉损害是否有关。结果采用内镜下经鼻蝶垂体病变切除手术患者中3例(6.7%)出现嗅觉损害,采用显微镜下经鼻蝶垂体病变切除手术患者中4例(14.8%)出现嗅觉损害,嗅觉损害发生率差异无统计学意义(P﹤0.05)。术后1个月,2例患者的嗅觉功能轻度减退,4例重度减退,1例嗅觉丧失。术后6个月,2例重度减退者好转,但未能恢复至正常水平,余患者均无明显改善。术后3?6个月鼻内镜检查发现所有患者的鼻腔伤口已愈合,2例患者鼻腔黏液分泌较多,3例患者术后鼻腔黏膜粘连。72例患者术中电灼蝶窦开口上方区域黏膜6例,均出现嗅觉障碍;鼻窥前端高于蝶窦开口上缘2例,均出现嗅觉障碍。结论经鼻蝶垂体病变切除手术并发嗅觉损害并不罕见,应予重视。鼻窥前端高于蝶窦开口上缘或电灼蝶窦开口上方区域黏膜可能是嗅觉损害的重要原因。Objective To explore the causes and precaution procedures of olfactory dysfunction after transsphenoidal surgery for pituitary lesions.Methods The clinical data of 72 patients underwent transsphenoidal surgery for pituitary lesions in our hospital from November 2016 to May 2018 were summarized.Resection under microscope was perfbnned in 27 patients and resection under endoscope in 45 patients.The olfactory function of patients with postoperative olfactory disorders was evaluated one and 6 months after surgery.Bilateral nasal passages were examined by nasal endoscopy 3-6 months after surgery.Whether intraoperative operations were related to olfactory impairment was analyzed.Results There were seven hyposmic/anosmic patients;three patients(6.7%)were operated via endoscopic approach and four patients(14.8%)were operated via microscopic transsphenoidal approach;incidence of olfactory dysfunction between the two groups showed no statistical difference(P>0.05).One month after operation,two patients had a slight decrease in olfactory function,4 had a severe decrease in olfactory function and one had anosmia.Six months after the operation,two patients with severe hypoxia got improvment,but failed to return to normal level;and the rest of the patients showed no significant improvement.Three-6 months after operation,nasal endoscopic examination found that all patients had healed nasal wound,two patients had large volume of nasal mucus secretion,and 3 patients had postoperative nasal mucosa adhesion.In these 72 patients,cauterization of the mucosa around the sphenoid ostium was performed in 6 patients,placement of the speculum above the sphenoid ostium was performed in 2 patients,and olfactory damage was noted in all the 8 patients.Conclusions Olfactory dysfunction after transsphenoidal surgery for pituitary lesions is common,and attention should be paid.Placement of the speculum above the sphenoid ostium and cauterization of the mucosa around the sphenoid ostium might be the main reasons for olfactory damage.

关 键 词：经鼻蝶手术 垂体病变 嗅觉损害 

分 类 号：R65[医药卫生—外科学] R76[医药卫生—临床医学]