内镜下经鼻腔-蝶窦入路手术并发症分析与防治

Complications of endoscopic transsphenoidal surgery

目的 分析内镜下经鼻腔-蝶窦入路手术常见并发症发生原因并探讨防治措施.方法 对我院2009年1月至2010年8月259例内镜下经鼻腔-蝶窦手术病历资料进行回顾性分析.结果 住院期间各类并发症总计31例,其中术中大出血2例,术后术区血肿2例,脑脊液鼻漏6例,垂体功能低下8例,尿崩4例,电解质紊乱4例,鼻衄3例,动眼神经麻痹1例,脑膜炎1例,因颅内血肿死亡1例,因颅内血肿行二次手术清除1例,脑脊液鼻漏行二次手术修补2例.出院后204例病例经3-18个月随访（平均7.3个月）,肿瘤复发5例,鼻衄1例,失嗅2例,鼻腔粘连1例,垂体功能低下2例.结论 内镜下经鼻腔-蝶窦手术与传统手术方式相比,手术损伤明显减少,但仍可发生多种手术并发症,并发症的预防和处理要求医护人员必须具备丰富的临床经验及多学科专业知识的积累.

Objective To discuss the prevention and treatment of the complications in endoscopic transsphenoidal surgeries. Method From January 2009 to August 2010,259 patients received endoscopic transsphenoidal surgery were analyzed. Results The complications in hospital were intraoperative massive hemorrhage（0. 8% ） in 2 cases,postoperative intracranial hematoma（0. 8% ） in 2,CSF leak（2. 3% ） in 6,pituitary hypofunction（3. 1% ） in 8,diabetes insipidus（ 1.5% ） in 4,electrolyte disturbance（ 1.5% ） in 4,epistaxis （ 1.2% ） in 3 ,oculomotor nerve palsy（0. 4% ） in 1 and meningitis（0. 4% ） in 1. After a follow - up of 204 patients for 3 - 18 months （ average 7. 3 months ）, 5 patient were recurrent （ 1. 9% ）, 1 epistaxis （0.4%） ,2 anosmia（0. 8% ）, 1 adhesion of nasal cavity （0. 4% ） and 2 pituitary hypofunction （0. 8% ）.Conclusions Endonasal transsphenoidal approach tends to present mainly fewer damage than traditional style. But we must be aware of the complications, and the prevention and treatment need more clinical experience and multi -disciplinary knowledge.