内镜下经蝶窦鞍区肿瘤切除术中脑脊液漏的处理

Treatment of cerebrospinal fluid leakage in the endoscopic resection of sellar tumor via endonasal transsphenoidal approach

目的分析内镜下经蝶窦入路鞍区肿瘤切除术中出现脑脊液漏的影响因素和处理方法。方法回顾性总结2007年1月至2009年1月246例经蝶窦手术过程中出现的脑脊液漏病例,分析出现脑脊液漏的原因,与肿瘤大小、性质、位置和类型的关系。结果内镜下经蝶窦入路鞍区肿瘤切除术中共出现脑脊液漏42例,经术中积极处理取得满意效果,除1例死亡外其余未出现脑脊液鼻漏。结论经蝶窦入路鞍区肿瘤切除术中脑脊液漏发生与术者操作,肿瘤大小、性质、位置和类型关系密切。术中采用自身组织填塞辅以人工材料,术后卧床,必要时采用腰穿蛛网膜下腔置管引流脑脊液能有效防止术后脑脊液鼻漏。

Objective To analyze factors and management of cerebrospinal fluid leakage in the resection of sellar tumor through endonasal transsphenoidal approach under endoscope.Methods The clinical data of patients with cerebrospinal fluid leakage in 246 cases underwent endoscopic resection of sellar tumor via endonasal transsphenoidal approach from January 2007 to January 2009 were reviewed.The causes of cerebrospinal fluid leakage and its relation to the tumor size,quality,location and type were analyzed.Results Cerebrospinal fluid leakage occurred in 42 cases in the resection of sellar tumor via transsphenoidal approach,but satisfactory results were achieved by careful management in the operation.No cerebrospinal fluid rhinorrhea occurred except for one dead case.Conclusion Cerebrospinal fluid leakage is associated with the management during operation,the tumor size,quality,location and type.Careful reconstruction using autologous tissues plus artificial materials during operation,bed rest postoperation,lumber drainage if necessary will effectively prevent the cerebrospinal fluid rhinorrhea postoperation.