术区原位取材骨-膜镶嵌技术在经蝶垂体瘤切除术中中等流量脑脊液漏中的应用  

Application of bone-mucosa embedding reconstruction with naso-sphenoidal in-situ autologous material on medium-flow cerebral spinal fluid leak during endoscopic endonasal surgery of pituitary adenoma

作　　者：高东 杨刚[1] 霍钢[1] 曹明川 周靖 王晓澍[1] GAO Dong;YANG Gang;HUO Gang;CAO Mingchuan;ZHOU Jing;WANG Xiaoshu(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,重庆400016

出　　处：《西安交通大学学报（医学版）》2022年第4期560-565,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的介绍经蝶垂体瘤切除术中术区原位取材骨质黏膜,结合硬膜缝合及骨-膜镶嵌技术对中等流量脑脊液漏的修补方法,并对照传统多层重建评价其效果。方法回顾性分析我院2016年9月至2020年3月神经内镜标准经蝶入路垂体瘤切除术中发生中等流量脑脊液漏病例的临床资料。根据术中重建方式分为2组。原位取材组:未行大腿或鼻腔的额外切口操作,原位取材骨-膜镶嵌+硬膜缝合,简称原位组。传统多层重建组:大腿脂肪+阔筋膜+鼻中隔带蒂黏膜瓣(pedicled nasoseptal flap,PNSF),简称传统组。分析比较两组相关指标的差异。结果原位组和传统组分别纳入108和63例,两组基线资料均衡可比。原位组相较于传统组,术后脑脊液漏发生率[(1/108,0.9%)vs.(1/63,1.6%),P>0.05]和颅内感染率[(2/108,1.9%)vs.(2/63,3.2%),P>0.05]无统计学差异;术后平均卧床时间[(3.7±1.6)d vs.(4.4±1.5)d,P<0.001]和术后平均住院日[(5.8±1.8)d vs.(6.5±1.7)d,P<0.001]明显缩短;嗅觉障碍发生率[(0/108,0%)vs.(3/63,4.8%),P<0.05]及鼻腔不适发生率[(3/108,2.8%)vs.(7/63,11.1%),P<0.05]明显降低。后续影像学及内镜检查见原位组重建结构稳定,无迟发性脑脊液漏。结论原位取材骨-膜镶嵌技术恢复了术区解剖层次,对标准经蝶入路垂体瘤切除术中的中流量漏口修补效果确切。其重建效果在达到传统方法水平的同时,避免了额外创伤,有利于缩短卧床及住院时间并改善患者主观体验,有较高的临床应用价值。Objective To introduce the repair application in medium-flow cerebrospinal fluid leakage during transsphenoidal pituitary tumor resection by using autologous material from the surgical site in situ,combined with dural suture and bone-mucosa embedding technique,and evaluate its effect.Methods We conducted a retrospective case analysis of medium-flow cerebrospinal fluid leakage during endoscopic transsphenoidal approach pituitary tumor resection in our hospital from September 2016 to March 2020.All the collected cases were divided into two groups.In situ material harvest group:dural suture+in situ bone-mucosa embedding,avoiding additional trauma to the thigh and nasal cavity,referred to as in situ group.Traditional multi-layer reconstruction group:fat+fascia lata+pedicled nasoseptal flap(PNSF),referred to as traditional group.The important indexes related to repair were compared and analyzed between the two groups.Results The in situ group and the traditional group consisted of 108 and 63 cases,respectively.The baseline data of the two groups were comparable.For the incidence of postoperative cerebrospinal fluid leakage[(1/108,0.9%)vs.(1/63,1.6%),P>0.05]and intracranial infection rate[(2/108,1.9%)vs.(2/63,3.2%),P>0.05],no statistical difference was shown between the groups.While compared with that in the traditional group,the mean postoperative bed stay time[(3.7±1.6)vs.(4.4±1.5)days,P<0.001]and the mean postoperative hospital stay[(5.8±1.8)vs.(6.5±1.7)days,P<0.001]of the in situ group were significantly shorter.The in situ group had significantly lower incidences of postoperative olfactory disturbance[(0/108,0%)vs.(3/63,4.8%),P<0.05]and nasal discomfort[(3/108,2.8%)vs.(7/63,11.1%),P<0.05].Follow-up imaging and endoscopic examination showed that the reconstructed structure of the in situ group was stable,and there was no delayed cerebrospinal fluid leakage.Conclusion This technique showed a reliable effect in repairing medium-flow leaks during transsphenoidal pituitary tumor resection by restoring the anatomica

关 键 词：自然腔道内镜手术 脑脊液鼻漏 颅底重建 术区原位取材 垂体肿瘤 缝合技术 

分 类 号：R730.56[医药卫生—肿瘤] R739.41[医药卫生—临床医学]