经鼻蝶入路显微镜下垂体腺瘤切除术后蝶窦的变化及蝶窦炎发生的相关因素分析  

Analyses of the changes of sphenoid sinus and related factors of sphenoid sinusitis after microscopic transsphenoidal pituitary adenoma resection

作　　者：秦勇 吴华伟 吴善武 屈洪艳 林昆哲 陈业煌 王守森 Qin Yong;Wu Huawei;Wu Shanwu;Qu Hongyan;Lin Kunzhe;Chen Yehuang;Wang Shousen(Department of Neurosurgery,Dongfeng General Hospital,Affiliated to Hubei Medical College,Shiyan 442001,China;Department of Neurosurgery,900 Hospital of the PLA Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]湖北医药学院附属东风医院神经外科,湖北十堰442001 [2]解放军联勤保障部队第九○○医院神经外科,福州350025

出　　处：《肿瘤研究与临床》2021年第1期48-52,共5页Cancer Research and Clinic

基　　金：福建省科技计划引导项目(2018Y0067);解放军联勤保障部队第九○○医院创新团队项目(2014CXTD07)。

摘　　要：目的探讨经鼻蝶入路显微镜下垂体腺瘤切除术后蝶窦腔的改变以及术后蝶窦炎发生的相关危险因素。方法连续性收集解放军联勤保障部队第九○○医院2012年8月至2015年3月106例垂体大腺瘤患者的临床和影像学资料,观察术前及术后不同时间点磁共振成像(MRI)蝶窦腔内积血、积液、炎症、黏液囊肿、黏膜重塑的改变。采用二元logistic多因素回归模型分析术后蝶窦炎发生的独立危险因素。结果MRI观察结果显示,蝶窦腔内积血、积液于术后3个月均吸收消散,鞍底骨窗缺损均由新生的黏膜覆盖,但尚不完全;鞍上残瘤均不同程度向鞍内下沉;术后6个月蝶窦黏膜重塑基本完全。106例患者中,术后3个月发现蝶窦黏液囊肿7例(6.6%),蝶窦炎症26例(24.5%)。多因素分析结果显示,生长激素型腺瘤(OR=2.981,95%CI 1.480~26.207,P=0.014)、术前蝶窦炎(OR=12.392,95%CI 2.927~52.462,P=0.001)、多次经鼻蝶入路手术频次(OR=14.758,95%CI 2.431~89.584,P=0.003)及术中脑脊液漏(OR=11.644,95%CI 2.175~62.344,P=0.004)是术后蝶窦炎发生的独立危险因素。结论经鼻蝶入路显微镜下垂体腺瘤切除术后蝶窦腔内容物的演变有其规律;生长激素型垂体腺瘤、术前蝶窦炎、多次经蝶手术及术中出现脑脊液漏患者,围术期需加强抗感染及鼻腔护理以降低术后出现蝶窦炎的可能;分期经鼻蝶入路垂体腺瘤切除再次手术的时机可能以前次手术后3个月左右为宜。Objective To investigate the changes of sphenoid sinus and related risk factors of sphenoid sinusitis after microscopic transsphenoidal pituitary adenoma resection.Methods The clinical and imaging data of 106 patients with large pituitary adenoma in 900 Hospital of the PLA Joint Logistics Team between August 2012 and March 2015 were continually collected.The changes of accumulated blood and fluid,inflammation,mucocele,mucosa remodeling in sphenoid sinus cavity at preoperative and postoperative different time points were observed through the analysis of magnetic resonance imaging(MRI).Binary logistic multiple factors regression model was used to analyze the independent risk factors for postoperative sphenoid sinusitis.Results MRI results showed that the blood and fluid accumulated in sphenoid sinus cavity were absorbed and dissipated 3 months after the surgery,and the saddle bone windows were covered by new mucous membrane at this time,but they were not complete;the remaining tumors in the saddle all sank into the saddle to different degrees.The reconstruction of sphenoid sinus mucosa was basically complete 6 months after the surgery.There were 7(6.6%)cases of mucocele in sphenoid sinus and 26(24.5%)cases of sphenoid sinusitis 3 months after the surgery among 106 patients.The results of multivariate analysis showed that growth hormone adenoma(OR=2.981,95%CI 1.480-26.207,P=0.014),preoperative sphenoid sinusitis(OR=12.392,95%CI 2.927-52.462,P=0.001),frequency of multiple transsphenoidal surgery(OR=14.758,95%CI 2.431-89.584,P=0.003)and perioperative cerebrospinal fluid leakage(OR=11.644,95%CI 2.175-62.344,P=0.004)were independent risk factors for postoperative sphenoid sinusitis.Conclusions The evolution of sphenoid sinus cavity contents has its own rules after microscopic transsphenoidal pituitary adenoma resection.Patients with growth-hormone pituitary adenoma,sinusitis before surgery,multiple transsphenoidal surgery and cerebrospinal fluid leakage during the surgery should receive enhanced anti-infection treatment

关 键 词：垂体肿瘤 鼻 显微外科手术 经鼻蝶入路手术 蝶窦炎 蝶窦黏膜 黏液囊肿 

分 类 号：R736.4[医药卫生—肿瘤]