内镜下经蝶窦垂体腺瘤切除术中脑脊液漏的处理

Repair of cerebrospinal fluid rhinorrhea created at the time of endoscopic endonasal transsphenoidal approach for pituitary adenomectomies

目的 分析内镜下经蝶窦入路垂体腺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7月～2009年6月239例垂体腺瘤经蝶窦手术过程中出现脑脊液漏的36例患者,分析经蝶窦入路垂体腺瘤切除术中脑脊液漏的原因,与肿瘤大小、性质和位置的关系。结果 内镜下经蝶窦入路垂体腺瘤切除术中虽然出现了脑脊液漏,但经术中积极处理后,术后效果理想,未出现脑脊液鼻漏。结论 经蝶窦入路垂体腺瘤切除术中脑脊液漏的原因和发生率文献报道较少,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地防止术后脑脊液鼻漏。

Objective To analyze influencing factors and treatment of cerebrospinal fluid leakage in the pituitary adenomectomies resection through Endoscopic endonasal transsphenoidal approach.Methods The clinical records of 36 patients,who had cerebrospinal fluid leakage in 239 cases of endoscopic endonasal transsphenoidal approach,were reviewed.To analyze the causes of cerebrospinal fluid leakage,it’s relation to the tumor size,nature and location.Results pituitary adenomectomies resection through transsphcnoidal approach may happen cerebrospinal fluid leakage,but carefull reconstruction on operation will get successful results.there is no cerebrospinal fluid rhinorrhea in 36 patients.Conclusion There is a rare reports about the causes and incidence of cerebrospinal fluid leakage in the pituitary adenomectomies resection through transsphcnoidal approach.it’s related to the experience of the surgeon,the tumor size,nature,location and type.Carefull reconstruction using autologous tissue plus artificial materials,postoperative lying in bed,lumber drainage on necessary will effectively prevent postoperative cerebrospinal fluid rhinorrhea.