原位骨瓣联合游离中鼻甲黏膜瓣在神经内镜扩大经蝶入路颅底重建中的应用  

Application of in situ bone flap combined with free middle turbinate mucosal flap in skull base reconstruction of endoscopic extended transsphenoidal approach

作　　者：金彪 王晓澍[1] 霍钢[1] 郑履平[1] 牟家民 彭明潜 周朝元 孙晓川[1] 杨刚[1] Jin Biao;Wang Xiaoshu;Huo Gang;Zheng Lyuping;Mou Jiamin;Peng Mingqian;Zhou Chaoyuan;Sun Xiaochuan;Yang Gang(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,400016

出　　处：《中华神经外科杂志》2020年第6期597-601,共5页Chinese Journal of Neurosurgery

摘　　要：目的介绍原位骨瓣联合游离中鼻甲黏膜瓣重建神经内镜扩大经蝶入路术后颅底缺损的方法,并初步探讨其应用效果。方法回顾性分析2019年5—12月重庆医科大学附属第一医院神经外科采用神经内镜扩大经蝶入路手术的21例患者的临床资料。其中颅咽管瘤19例,鞍上蛛网膜囊肿2例。患者均采用原位骨瓣联合游离中鼻甲黏膜瓣进行颅底重建。术后均行临床和影像学随访,观察患者的术后并发症和颅底重建情况。结果21例患者的重建骨瓣均一次形成,术后当日鞍区薄层CT显示骨瓣无移位。术后视力改善11例,无变化10例。术后发生脑脊液漏合并颅内感染1例,疑似颅内感染2例,3例均行腰大池引流术治愈。无二次手术修补脑脊液漏的患者和死亡患者。21例患者的术后中位随访时间为4个月(3~10个月),患者均恢复良好,术后无迟发性脑脊液漏发生,无鼻腔不适症状,鞍区薄层CT显示骨瓣均有不同程度愈合,其中19例患者的鞍区增强MRI显示游离中鼻甲黏膜瓣强化,提示黏膜瓣生长良好。结论应用原位骨瓣联合游离中鼻甲黏膜瓣重建神经内镜扩大经蝶入路术后颅底缺损,不仅可以达到良好的重建效果,而且可以减少鼻腔创伤,对降低二次手术风险亦有积极作用。Objective To introduce the technique of in situ bone flap(ISBF)combined with free middle turbinate mucosal flap(FMTMF)to reconstruct the defect during endoscopic extended transsphenoidal approach(EETA)and to preliminarily evaluate its efficiency.Methods A retrospective study was conducted on the clinical data of 21 patients who underwent operation through EETA between May 2019 and December 2019 at Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University.Among them,there were 19 cases of craniopharyngioma and 2 cases of suprasellar arachnoid cyst.All 21 patients underwent skull base reconstruction using ISBF combined with FMTMF.The complications and efficiency of reconstruction were analyzed by clinical and imaging follow-up post operation.Results The ISBF of 21 patients was achieved one time during operation.Thin-slice CT in the saddle area on the day after the operation showed no shift of bone flaps.Visual improvement was reported in 11 patients and no visual improvement in 10.After surgery,1 patient had CSF leakage complicated with intracranial infection,and 2 patients were suspected of intracranial infection,and those 3 patients underwent lumbar drainage.There was no operation of a second CSF leak repair or death.Postoperative follow-up of 21 patients lasted for a median of 4 months(3-10 months).The patients recovered well and had no intranasal discomfort and delayed CSF leakage after surgery.The thin-slice CT in the saddle area showed that the bone flaps had different degrees of healing,of which 19 patients showed hyperenhancement in the FMTMF on contrast-enhanced MRI of the saddle area indicating good growth of FMTMF.Conclusion Application of ISBF combined with FMTMF in skull base reconstruction of EETA seems to be associated with an excellent reconstruction result and reduction of nasal trauma,which also has a positive effect on reducing the risk of secondary surgery.

关 键 词：自然腔道内镜手术 脑脊液鼻漏 颅底重建 原位骨瓣 游离中鼻甲黏膜瓣 

分 类 号：R651.1[医药卫生—外科学]