神经内镜下单鼻孔经蝶手术中的蝶鞍修复

Repair of the sella turcica during endonasal endoscopic transsphenoidal surgery

目的为了介绍神经内镜单鼻孔经蝶入路切除鞍区病变后行蝶鞍修复的技术方法与临床效果。方法235例鞍区病变患者行神经内镜单鼻孔经蝶手术切除后有鞍底缺损,均用生物材料和自体组织行修复,对本组每一个病例的蝶鞍修复不同技术都作了复习。结果全组患者于神经内镜术后均视为需要作蝶鞍修复者,其主要理由是术中开放了鞍底,或出现脑脊液漏。在经过蝶鞍修复和腰蛛网膜下腔引流后,患者都未发生永久性脑脊液鼻漏或其他并发症。结论对采用神经内镜经蝶手术的患者有必要行鞍底修复,而选择合适的材料是成功进行鞍底修复的关键。

Objective To describe techniques and clinical effects used in repair of the sella turcica during endoscopic endonasal transphenoidal surgery for sellar region lesions. Methods Two hundred and thirty-five patients with defects in the floor of the sella turcica, after endoscopic endonasal transsphenoidal surgery, underwent repair with biomaterial and autologous tissues. Different techniques of sellar reconstruction and indications for each specific condition were reviewed in a series of the consecutive patients. Results All patients in our group were considered the candidates for sellar reconstruction after the endoscopic operation, mainly because of intraoperative sellar floor open or cerebrospinal fluid leaks. Patients who underwent the sellar repair and lumbar subarachnoid cavity drainage did not show postoperative cerebrospinal leak or other complications permanenfly. Conclusion Repair of the sellar floor is considered necessary in the patients who underwent operations via the endoscopic transsphenoidal approach. It is important to select suitable materials for successful reconstruction of the sellar floor.