原位骨瓣联合带蒂鼻中隔黏膜瓣在扩大经蝶入路颅底重建中的临床应用  

Clinical Application of in Situ Bone Flap Combined with Hadad-Bassagasteguy Flap in Skull Base Reconstruction via an Endoscopic Extended Transsphenoidal Approach

作　　者：季文霞 王然[1] 黄清 王奎吉 Ji Wenxia;Wang Ran;Huang Qing;Wang Kuiji(Department of Otolaryngology,Head and Neck Surgery,Sichuan Science City Hospital,Mianyang 621900,China;Rhinology Speciality,Department of Otolaryngology,Head and Neck Surgery,Beijing Tongren Hospital,Beijing 100005,China)

机构地区：[1]四川省科学城医院耳鼻咽喉头颈外科,绵阳621900 [2]北京同仁医院耳鼻咽喉头颈外科鼻科,北京100005

出　　处：《成都医学院学报》2022年第6期734-737,共4页Journal of Chengdu Medical College

基　　金：绵阳市卫生健康委员会2020年科研课题(No:202002)。

摘　　要：目的分析原位骨瓣(ISBF)联合带蒂鼻中隔黏膜瓣(HBF)在内镜扩大经蝶入路(EETA)颅底重建中的临床应用。方法选取2017年7月至2020年7月于四川省科学城医院施行EETA颅底重建的107例颅内肿瘤患者为研究对象。将EETA术中联合人工骨基质、HBF进行颅底重建的患者纳入对照组(n=50),将EETA术中联合ISBF、HBF进行颅底重建的患者纳入试验组(n=57),对比两组手术住院情况、手术效果和术后不良反应发生情况。结果术后病理学检查结果显示,107例患者中有89例垂体腺瘤、9例Rathke囊肿、2例生殖细胞瘤、7例颅咽管瘤,两组病理类型比较,差异无统计学意义(P>0.05)。试验组术后首次下床时间、住院时长明显短于对照组(P<0.05)。术后30 d,试验组疗效等级明显优于对照组(P<0.05);试验组脑脊液漏发生率明显低于对照组(P<0.05);两组逆行感染、张力性气颅、鼻腔并发症发生率比较,差异无统计学意义(P>0.05)。结论在EETA颅底重建中联合应用ISBF、HBF可促进患者术后恢复,优化疗效,减少术后不良反应发生风险。Objective To analyze the clinical effect of in situ bone flap(ISBF)combined with hadadbassagasteguy flap(HBF)in skull base reconstruction via an endoscopic extended transsphenoidal approach(EETA).Methods A total of 107 patients who underwent skull base reconstruction via EETA in Sichuan Science City Hospital from July 2017 to July 2020 were selected as the research subjects.Patients in the control group(n=50)received artificial bone matrix combined with HBF in skull base reconstruction via EETA,while patients in the experimental group(n=57)received ISBF combined with HBF in skull base reconstruction via EETA.Surgical conditions,surgical effects and adverse reactions were compared between the two groups.Results Postoperative pathological examination showed that among the 107 patients,there were 89 patients with pituitary adenomas,9patients with Rathke’s cysts,2 patients with germ cell tumors,and 7 patients with craniopharyngiomas.There was no significant difference in pathological types between the two groups(P>0.05).The postoperative first ambulation time and length of hospital stay in the experimental group were significantly shorter than those in the control group(P<0.05).On the 30th day after operation,the curative effect grade in the experimental group was significantly better than that in the control group(P<0.05).The incidence of cerebrospinal fluid leakage in the experimental group was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence of retrograde infection,tension pneumocephalus,and nasal complications between the two groups(P>0.05).Conclusion The combined application of ISBF and HBF in skull base reconstruction via EETA can help promote the postoperative recovery process of patients,improve the curative effect,and reduce the risk of postoperative adverse events.

关 键 词：内镜扩大经蝶入路 颅底重建 原位骨瓣 带蒂鼻中隔黏膜瓣 

分 类 号：R651.1[医药卫生—外科学]