鞍区病变经蝶手术中鞍底生理重建和鼻咽通气道的应用

Physiological sellar reconstruction and application of nasopharyngeal parichnos in transsphenoidal microsurgery for lesions in sellar region

目的总结鞍区病变经蝶手术中鞍底生理重建和鼻咽通气道的应用经验和体会。方法本组垂体腺瘤37例,Rathke囊肿5例,垂体无功能腺瘤经蝶术后瘢痕形成1例,垂体脓肿1例,颅咽管瘤1例,鞍区生殖细胞瘤1例。方法均采用经单鼻孔蝶窦显微手术方式,术中争取采用手术入路中获得的自体骨质重建鞍底,以自制简易带球囊鼻咽通气道进行鼻腔填塞。结果 45例患者在经蝶手术入路中能获得较完整的自体骨片。38例患者术中做到了自体骨质鞍底重建,鞍底骨质重建的来源分别为:骨性鼻中隔4例,蝶窦腹侧壁骨质26例,蝶窦纵隔6例,蝶窦横隔2例。经蝶手术中脑脊液漏者14例均做到了术中自体骨质重建鞍底,术后均无脑脊液漏。上述鞍底骨质重建病例术后1d均可起床下地活动。40例患者非手术侧鼻腔置入带球囊鼻咽通气道,6例患者双侧鼻腔均置入带球囊鼻咽通气道,上述病例术后均可经鼻腔呼吸。结论绝大部分鞍区病变尤其是垂体腺瘤经蝶窦手术中可以做到自体骨质重建鞍底。无论术中是否有过脑脊液漏,鞍底生理重建病例术后起床下地活动时间早。自制简易带球囊鼻咽通气道填塞鼻腔是一种简单易行的鼻腔填塞方法 ,可以满足经蝶窦手术的鞍区病变患者鼻腔填塞和正常呼吸生理的需要。

Objective To summarize our experience and comprehension in the physiological sellar reconstruction and application of nasopharyngeal parichnos in transsphenoidal mierosurgery for lesions in sellar region. Methods The 46 lesions in sellar region include 37 pituitary adenomas ,5 Rathke cysts, 1 postoperative scar after former transsphenoidal mierosurgery for non-functional pituitary adenoma, 1 pituitary abscess, 1 eraniopharingioma and 1 germinoma. All the patients received transnasal and transsphenoidal microsurgery, during which effort was made to reconstruct the sellar floor with autogenous bone flap acquired during the operative approach and proceed the nasal packing with homemade nasopharyngeal pariehnos with saeculus. Results Intact autogenous bone flaps were acquired in 45 cases during the operative approach. Setlar reconstruction with autogenous bone flaps was achieved in 38 cases. The sources of autogenous bone flaps for sellar reconstruction included osteoseptum in 4 cases, paries ventralis of sphenoid sinus in 26 cases, mediastinum of sphenoid sinus in 6 cases, and tabula of sphenoid sinus in 2 cases. All the 14 cases with intraoperative cerebrospinal fluid（CSF） leakage received sellar reconstruction with autogenous bone flap and had no postoperative CSF leakage. All above cases with sallar reconstruction could get up to walk one day postoperative. 40 cases received nasal packing with homemade nasopharyngeal parichnos with sacculus in non-operative side, and 6 cases in both sides. All above patients can breathe through their nasopharynx. Conclusions It is simple and easy to reconstruct sellar floor with autogenous bone flap acquired during transsphenoidal approach in transsphenoidal mierosurgery for most lesions in sellar region, especially for pituitary adenomas, which can make the patients get up to walk early, no matter whether there is intraoperative CSF leakage or not. Nasal packing with homemade nasopharyngeal parichnos with sacculus is an easy and simple method, which can satisfy both nasal packing and normal physiological breathing for patients with lesions in sellar region receiving transsphenoidal mierosurgery.