侵袭性垂体腺瘤术后延迟性脑脊液鼻漏相关因素分析及处理  

Analysis and management of delayed cerebrospinal fluid rhinorrhea after invasive pituitary adenoma surgery

作　　者：张强[1] 薛凯[2] 马越[2] 翟翔[1] 刘钢[1] 张金玲[1] 于焕新[1] 杭伟[1] Zhang Qiang;Xue Kai;Ma Yue;Zhai Xiang;Liu Gang;Zhang Jinling;Yu Huanxin;Hang Wei(Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院耳鼻咽喉头颈外科,天津300350 [2]天津市环湖医院神经外科,天津300350

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第3期301-307,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：天津市卫生健康科技人才培育项目(KJ20168)。

摘　　要：目的:探讨侵袭性垂体腺瘤(invasive pituitary adenoma,IPA)术后发生延迟性脑脊液鼻漏的相关因素及处理方法。方法:回顾性分析2014年1月至2019年1月就诊于天津市环湖医院并行手术治疗的IPA患者142例,其中男62例,女80例,年龄38~67岁。收集患者手术前后的临床资料,对术后发生脑脊液鼻漏者均行内镜下脑脊液鼻漏修补术,扩大切除漏口周围硬脑膜,去除坏死组织,同时切除残留或复发垂体腺瘤,应用多层材料修补脑脊液漏口;对于术后仍有术腔漏液者,内镜下再次清理术腔坏死组织并行脑脊液鼻漏修补术。对术后发生延迟性脑脊液鼻漏的相关危险因素进行分析。采用SPSS 19.0软件对数据进行统计。结果:本组142例患者中,肿瘤全切者64例,非全切者78例,术后随访6~72个月,发生延迟性脑脊液鼻漏者31例,发生率21.83%,发生时间为术后1~5年,平均2.4年。对延迟性脑脊液鼻漏者行内镜下脑脊液鼻漏修补术,术后2周、1个月、3个月、6个月复查鼻内镜,其中28例患者经1次、2例患者经2次、1例患者经3次内镜手术后修补成功。术后随访6~60个月,未再出现脑脊液鼻漏。单因素分析结果显示,肿瘤切除程度、复发、大小、质地、术后放疗和术者经验为术后发生延迟性脑脊液鼻漏的危险因素( P值均<0.05)。多因素分析结果显示,肿瘤切除程度和复发为术后发生脑脊液鼻漏的最高独立危险因素,肿瘤大小、质地、术后放疗和术者经验为本研究的独立危险因素。 结论:IPA术后并发延迟性脑脊液鼻漏与肿瘤切除程度、复发、大小、质地、术后放疗和术者经验有关。对这类患者应于内镜下扩大切除漏口周围硬脑膜及坏死组织,对缺损部位进行多层材料修补,术后密切随访、及时补救。Objective To investigate the related factors and treatments of delayed cerebrospinal fluid rhinorrhea(CFR)after invasive pituitary adenoma(IPA)surgery.Methods One hundred and forty-two patients with IPA treated in Tianjin Huanhu Hospital from January 2014 to January 2019 were analyzed retrospectively,including 62 males and 80 females,aging from 38 to 67 years.The clinical data of patients before and after operation were collected.All patients with postoperative CFR underwent endoscopic CFR repair.During the operation,residual or recurrent pituitary adenomas were resected,the dura around the leak was enlarged and the necrotic tissue was removed.For those who still had fluid leakage after repair,the necrotic tissue was cleaned up,the leakage was filled and reinforced under endoscopy.Endoscopic rhinorrhea repair was performed if necessary.The cerebrospinal fluid leak was repaired with multi-layer materials.The related risk factors of delayed CFR after operation were analyzed.SPSS 19.0 software was used for statistical analysis.Results Among the 142 patients in this group,64 cases underwent total tumor resection and 78 cases underwent non-total tumor resection.They were followed up for 6 to 72 months.Thirty-one cases had delayed CFR,with an incidence of 21.83%,and occurred between 1 and 5 years postoperatively,with an average of 2.4 years.All 31 patients with delayed CFR underwent endoscopic CFR repair.The nasal endoscopy was rechecked at 2 weeks,1 month,3 months and 6 months after operation.Twenty-eight patients were repaired successfully after 1 operation,while 2 patients after 2 operations and 1 patient after 3 operations.These patients were followed up for 6 to 60 months,and no CFR occurred again.Univariate analysis showed that the degree of tumor resection,recurrence,size,texture,postoperative radiotherapy and operator experience were the risk factors of delayed CFR(all P<0.05).Multivariate analysis showed that the degree of tumor resection and recurrence were the highest independent risk factors for postoperati

关 键 词：垂体腺瘤 侵袭性 脑脊液鼻漏 

分 类 号：R736.4[医药卫生—肿瘤]