以筛动脉为蒂的鼻中隔鼻底黏膜瓣在经蝶垂体瘤术后脑脊液漏修补中的应用  

Application of ethmoid artery pedicled septal floor mucosa flap in repair of postoperative cerebrospinal fluid leak after transsphenoidal pituitary surgery

作　　者：孙汐文 茆松 唐如 李志鹏 骆春雨 檀少林 张维天 SUN Xiwen;MAO Song;TANG Ru;LI Zhipeng;LUO Chunyu;TAN Shaolin;ZHANG Weitian(Department of Otolaryngology Head and Neck Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,200233,China;JinzhouMedical University Postgraduate Training Base)

机构地区：[1]上海交通大学医学院附属上海市第六人民医院耳鼻咽喉头颈外科,上海200233 [2]锦州医科大学研究生培养基地(上海市第六人民医院)

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第2期136-140,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：上海申康医院发展中心临床科技创新项目(No:SHDC12020129);国家自然科学基金(No:82071014,81870700,82271137,82000951)。

摘　　要：目的:探讨采用以筛动脉为蒂的鼻中隔鼻底黏膜瓣修复经蝶垂体瘤术后脑脊液漏的安全性及有效性。方法:回顾上海交通大学医学院附属上海市第六人民医院耳鼻咽喉头颈外科2011年6月—2022年6月收治的6例垂体瘤术后脑脊液漏患者的临床资料,因既往手术采用内镜经蝶扩大入路破坏了双侧鼻中隔后动脉,手术采用以筛动脉为蒂的鼻中隔鼻底黏膜瓣进行修补。结果:6例患者术后随访黏膜瓣均生长良好,未再发生脑脊液漏。结论:垂体瘤术后的高流量脑脊液漏临床修复困难,对于经蝶入路破坏双侧鼻中隔后动脉的患者,其经典的鼻中隔后动脉黏膜瓣不可用,以筛动脉为蒂的鼻中隔鼻底黏膜瓣是可选择的方法之一。Objective:To investigate the safety and effectiveness of the ethmoid artery pedicled septal floor mucosal flap in repair of postoperative cerebrospinal fluid leakage after transsphenoidal pituitary tumor surgery.Methods:The clinical data of 6 patients with cerebrospinal fluid leak in Department of Otolaryngology Head and Neck Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to June 2022.In 6 patients with postoperative cerebrospinal fluid leakage after transsphenoidal pituitary surgery,the bilateral posterior septal arteries were sacrificed due to the endoscopic transsphenoidal expanded approach,so the ethmoid artery pedicled septal floor mucosal flaps were adopted.Results:All patients had good growth of the mucosal flaps during postoperative follow-up without recurrent cerebrospinal fluid leakage.Conclusion:Cerebrospinal fluid leakage is still one of the postoperative complications of pituitary surgery.For patients with bilateral posterior septal arteries sacrificed through the transsphenoidal approach,when the classic posterior septal artery pedicled mucosal flap is not available,the ethmoid artery pedicled septal floor mucosal flap is one of the alternative methods.

关 键 词：垂体瘤 脑脊液漏 筛动脉 鼻中隔鼻底黏膜瓣 

分 类 号：R736.4[医药卫生—肿瘤]