Willis覆膜支架在经鼻内镜垂体瘤切除术中颈动脉破裂患者中的应用及随访  

Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection:an application and follow-up study

作　　者：汪勇锋[1] 夏金超 张坤[1] 顾建军 王子亮[1] 薛绛宇[2] 李钊硕[1] 邱茜茜 朱方涛[4] 高慧丽[1] 李天晓[1] Wang Yongfeng;Xia Jinchao;Zhang Kun;Gu Jianjun;Wang Ziliang;Xue Jiangyu;Li Zhaoshuo;Qiu Xixi;Zhu Fangtao;Gao Huili;Li Tianxiao(International Joint Laboratory of Cerebrovascular Disease of Henan Province,Cerebrovascular Department of Carotid Artery Disease Sub-department,Henan Provincial People's Hospital,Zhengzhou 450003,China;Neurosurgery Department of Complex Surgery Sub-department,Henan Provincial People's Hospital,Zhengzhou 450003,China;Neurosurgical Intensive Care Unit,Central Hospital of Jiaozuo Coal Industry(Group)Co.,LTD,Jiaozuo 454000,China;Department of Interventional Surgery,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]河南省人民医院脑血管病区-颈动脉疾病亚专科,河南省脑血管病国际联合实验室,郑州450003 [2]河南省人民医院神经外科复合手术亚专科,郑州450003 [3]焦作煤业(集团)有限责任公司中央医院神经重症科,焦作454000 [4]郑州大学第二附属医院介入科,郑州450014

出　　处：《中华神经医学杂志》2022年第4期359-364,共6页Chinese Journal of Neuromedicine

基　　金：河南省科技攻关项目(202102310409)。

摘　　要：目的探讨Willis覆膜支架置入治疗经鼻内镜垂体瘤切除术中颈动脉破裂的有效性、安全性。方法回顾性分析河南省人民医院、郑州大学第二附属医院及焦作煤炭中央医院神经外科自2016年5月至2019年12月收治的6例经鼻内镜垂体瘤切除术中发生颈动脉破裂患者的临床资料,总结其处理方式和并发症发生情况,采用改良Rankin量表(mRS)评分评估患者的预后。结果1例患者采用术中单纯填塞压迫止血,术后2周出现颅内大出血后死亡。5例患者接受Willis覆膜支架置入术治疗,破裂口均封堵成功但眼动脉闭塞;围手术期发生尿崩症1例,不完全动眼神经瘫痪1例;5例患者随访3~12个月,MRI检查显示肿瘤次全切4例,全切1例,均预后良好,无新增出血或缺血事件发生。结论Willis覆膜支架置入治疗经鼻内镜垂体瘤切除术中颈动脉破裂安全有效。Objective To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods A retrospective analysis was performed.Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen;their clinical data were collected.The surgical processes and complications were concluded,and the prognoses were evaluated by modified Rankin scale(mRS).Results One patient was treated with intraoperative simple tamponade compression for hemostasis,and died for massive intracranial hemorrhage 2 weeks after surgery.Five patients were occluded by Willis covered stents;the occluded success rate was 100%but ophthalmic arteries were blocked in all.During the perioperative period,diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient;5 patients were followed up for 3-12 months:MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient,no new bleeding or ischemic stroke events occurred in these 5 patients,and the prognosis was good.Conclusion Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

关 键 词：神经内镜 垂体瘤 颈动脉破裂 覆膜支架 

分 类 号：R736.4[医药卫生—肿瘤]