内镜经鼻颅底重建失败的影响因素分析  

Analysis of risk factors for the failure of endoscopic endonasal skull base reconstruction

作　　者：颜旭东[1] 王琳[1] 谭瑞峰 于龙刚[1] 张继生[1] 韩琳[2] 张胜男 姜彦[1] Yan Xudong;Wang Lin;Tan Ruifeng;Yu Longgang;Zhang Jisheng;Han Lin;Zhang Shengnan;Jiang Yan(Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Hospital of Qingdao University,Qingdao266000,China)

机构地区：[1]青岛大学附属医院耳鼻咽喉头颈外科,青岛266000 [2]青岛大学附属医院痛风病重点实验室,青岛266000

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第11期1159-1164,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81770978);山东省自然科学基金(ZR2023MH027)。

摘　　要：目的分析内镜经鼻颅底手术(endoscopic endonasal skull base surgery, EESBS)颅底重建失败的影响因素。方法回顾性分析2018—2023年间青岛大学附属医院收治的228例EESBS病例, 收集并分析与颅底重建相关的临床特征, 以及术后脑脊液漏的病例特点。采用Lasso回归初步探索, 并进一步通过多因素Logistic回归分析重建失败的危险因素。结果本研究队列纳入157例EESBS病例, 总体重建失败率为11.5%(18/157)。二期重建采用带蒂黏膜瓣或多层游离黏膜及筋膜修补的患者, 术后均未再出现脑脊液漏。Lasso回归筛选出的变量为手术史、放疗史和漏点部位, 通过多因素Logistic分析显示放疗史(OR=5.96, P=0.021)和漏点部位位于后颅底(OR=8.70, P=0.003)是颅底重建失败的影响因素。结论对于术区有放疗史和/或后颅底病变的病例, 如术中出现脑脊液漏, 应加强重建策略以提高一期成功率。Objective To analyze the influencing factors of skull base reconstruction failure after endoscopic endonasal skull base surgery(EESBS).Methods A retrospective analysis was performed on 228 EESBS cases at the Affiliated Hospital of Qingdao University from 2018 to 2023.The clinical features associated with skull base reconstruction and postoperative cerebrospinal fluid leakage were collected and analyzed.Lasso regression was initially used for exploratory analysis,and risk factors for reconstruction failure were subsequently evaluated using multifactorial logistic regression.Results A total of 157 cases of EESBS were included,with an overall reconstruction failure rate of 11.5%(18/157).No patients who underwent second-stage reconstruction with a tipped mucosal flap or multilayered free mucosal and fascial repair experienced further postoperative cerebrospinal fluid leakage.Variables identified through Lasso regression included history of surgery,history of radiotherapy,and site of leakage.Multifactorial logistic analysis showed that history of radiotherapy(OR=5.96,P=0.021)and site of leakage in the posterior skull base(OR=8.70,P=0.003)were significant risk factors for failure of skull base reconstruction.ConclusionIn cases with a history of radiotherapy and/or posterior skull base lesions in the operative area,reconstruction strategies should be strengthened to improve the success rate of one-stage repair,in particular,when intraoperative cerebrospinal fluid leakage occurs.

关 键 词：耳鼻喉外科手术 颅底重建 术后脑脊液漏 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]