改良补救带蒂鼻中隔黏膜瓣在神经内镜经鼻蝶垂体腺瘤切除术中行脑脊液漏修补的应用  

Modified remedial tipped nasal septal mucosal flap in neuroendoscopic transnasal pterygoid pituitary adenoma resection for cerebrospinal fluid leak repair

作　　者：孙子康 王安硕 何章鸣 陈殿升 张文 王飞 SUN Zikang;WANG Anshuo;HE Zhangming;CHEN Diansheng;ZHANG Wen;WANG Fei(Department of Neurosurgery,Anhui Provincial Hospital,Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院神经外科,合肥230001

出　　处：《中国临床保健杂志》2024年第5期664-668,共5页Chinese Journal of Clinical Healthcare

基　　金：国家自然科学基金面上项目(52073269)。

摘　　要：目的探讨以改良补救带蒂鼻中隔黏膜瓣为主的修补方式在神经内镜经鼻蝶垂体腺瘤切除术中行术中脑脊液漏修补的实用性。方法回顾性分析在2021年1月至2023年11月安徽医科大学附属省立医院行神经内镜经鼻蝶垂体腺瘤切除术,且术中出现脑脊液漏且行脑脊液漏修补术的患者资料,选择使用改良补救带蒂鼻中隔黏膜瓣进行修补的研究组患者共20例,用传统鼻中隔黏膜瓣进行修补的对照组患者共22例,比较2组间患者一般资料、术中情况和术后并发症。结果研究组手术用时[182.5(140.0,243.8)min]比对照组[240.0(182.8,303.5)min]短,P=0.017。研究组术后嗅觉减退(1/20)较对照组(8/22)少,P=0.036。研究组20例患者均得到良好的修补效果,无术后脑脊液漏出现;对照组中21例患者得到成功修补,仅1例患者术后出现脑脊液漏,再次行手术治疗后好转;2组修补成功率差异无统计学意义(P>0.05)。2组围术期均无感染、死亡等严重并发症,随访期内无死亡及失访病例。结论使用改良补救带蒂鼻中隔黏膜瓣安全可行,可缩短手术时间,有效减少术后患者嗅觉减退的发生率。Objective To investigate the role and utility analysis of the modified remedial tipped nasal septum mucosal flap-based repair in neuroendoscopic transnasal butterfly pituitary adenoma resection for intraoperative cerebrospinal fluid leak repair.Methods Retrospective analysis of neuroendoscopic transsphenoidal pituitary adenoma resection performed at Anhui Medical University Affiliated Provincial Hospital from January 2021 to November 2023,and a total of 20 patients were chosed in the study group using modified remedial tipped nasal septal mucosal flap,and a total of 22 patients in the control group using traditional nasal septal flap to statistically analyze the general information of patients,intraoperative conditions,and the practicality of repairing cerebrospinal fluid leakage among the two groups.General information,intraoperative conditions,postoperative complications were counted between the 2 groups during the follow-up.Results The duration of surgery was shorter in the study group[182.5(140.0,243.8)min]than that in the control group[240.0(182.8,303.5)min],P=0.017.Postoperative olfactory hyperalgesia was less in the study group(1/20)than in the control group(8/22),P=0.036.The 20 patients in the study group received good repair results and no postoperative There was no postoperative cerebrospinal fluid leakage in the study group;in the control group,21 patients were successfully repaired,and only 1 patient had postoperative cerebrospinal fluid leakage,which was improved after reoperation;there was no statistically significant difference in the success rate of the repair in the two groups(P>0.05).There was no case of infection,death and other serious complications during the perioperative period in the two groups,and there were no deaths and no loss of visit cases during the follow-up.Conclusions The use of the modified remedial tipped septal mucosal flap is safe and feasible,which can shorten the operation time to a certain extent and can effectively reduce the incidence of postoperative olfactory hyperalge

关 键 词：垂体肿瘤 神经内窥镜检查 脑脊液漏 嗅觉丧失 

分 类 号：R736.4[医药卫生—肿瘤]