经单侧鼻腔蝶窦入路垂体手术并发症的防范与处理  

Prevention and management of complications of transsphenoidal microsurgery for pituitary adenomas

作　　者：孙炜[1] 庞琦[1] 魏林[1] 孙金龙[1] 王成伟[1] 宋涛[1] 郝晓光[1] 孟庆虎[1] 王益华[1] 朱百年[1] 张庆林[1] 

机构地区：[1]山东大学第二医院神经外科,山东济南250033

出　　处：《中国微侵袭神经外科杂志》2003年第2期52-56,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨经单侧鼻腔蝶窦入路垂体手术并发症的防范与处理。方法回顾性分析1994年4月～2002年12月1152例经单侧鼻腔蝶窦入路垂体腺瘤手术并发症。结果手术病死率0.2%。脑脊液鼻漏的发生率2.7%,其中1.8%自行停止,0.8%行腰穿置管引流,0.2%行2次手术修补。尿崩的发生率为4.7%,4.1%为一过性,0.6%为持久性。其他并发症如眼球运动神经损伤、脑膜炎、鞍内血肿、鼻出血、脑损伤等的发生率为0.1%～0.2%。结论熟知局部的相关解剖,不断提高手术技巧,将有助于进一步降低经蝶窦垂体手术并发症的发生。Objective To evaluate the complications of transsphenoidal microsurgery for pituitary adenomas, and discuss the problems of effective prevention and management. Methods 1152 consercutive transsphenoidal procedures for pituitary adenomas from April, 1994 to December, 2002 were reviewed retrospectively to evaluate complications. Results The overall operative mortality was 0.2%. Cerebrospinal fluid rhinorrhea occurred in 2.7% of patients, in 1.8% resolved spontaneously, in 0.8% required lumber drainage, and in 0.2% required reoperation. Diabetes insipidus occurred in 4.7% of patients, in 4.1% was transient, and in 0.6% was permanent. Other significant complications, such as ophthalmoplegia, meningitis, intrasellar hematoma, epistaxis, brain injury, occurred with incidence rates between 0.1% and 0.2%. Conclusions Better understanding the reginal anatomy and improving microsurgical techniques and strategies should further lower the incidence of mortality and mobidity.

关 键 词：垂体腺瘤 经蝶窦显微手术 并发症 脑脊液鼻漏 尿崩 

分 类 号：R736.4[医药卫生—肿瘤]