垂体腺瘤经鼻蝶入路术后出血的原因及防治

Post-operative hemorrhage after transsphenoidal surgery in patients with pituitary adenoma: a retrospective analysis

目的探讨经鼻蝶入路垂体腺瘤切除术后出血的原因、防治以及预后。方法回顾分析我院神经外科876例经鼻蝶入路切除垂体腺瘤患者中17例术后并发出血患者的临床资料,并结合文献加以讨论。结果 11例鞍内出血患者中6例为残瘤出血所致,5例与鞍内填塞物过多有关;其中9例行经蝶手术清除血肿,7例视力恢复正常,2例遗留单侧视力障碍。6例鞍上出血患者中4例为残留肿瘤出血经破裂鞍膈进入颅内所致,2例与术中鞍膈短时间较大幅度下降有关,该6例均行开颅手术清除血肿,意识和视力恢复各1例,死亡1例,余3例长期昏迷。结论垂体腺瘤术后无论是鞍上还是鞍内出血都是严重的并发症,鞍内出血只要及时发现和处理一般预后良好。鞍上出血常提示预后不良,须以预防为主。

Objective The possible causes, management and prognosis of post-operative hemorrhage after transsphenoidal surgery in patients with pituitary adenoma are discussed.Methods Among 876 consecutive cases with pituitary adenoma undergone transsphenoidal surgery, post-operative hemorrhage occurred in 17 cases.The clinical data were analyzed retrospectively and discussed with the related literatures.Results In all 11 cases with intrasella hemorrhage, six hemorrhagic cases were due to residual tumor bleeding and 5 cases due to intrasella overpacking of hemostasis materials.In nine cases underwent hematoma evacuation, 7 cases got good recovery of visual acuity and 2 cases remained unilateral visual impairment.Four cases were related to residual tumor bleeding into subarachnoidal space through the ruptured diaphragma sellae and 2 cases probably related to rapid collapse of diaphragma sellae intra-operatively in 6 cases with suprasella hemorrhage.The hematoma evacuation by craniotomy were performed in all 6 cases, and 1 case got recovery of visual acuity, 1 case got complete recovery of consciousness, 1 dead case and 3 cases remained coma status.Conclusion Both post-operative intrasella and suprasella hemorrhage after transsphnoidal surgery for pituitary adenomas should be considered as severe complications and need appropriate management as soon as possible.Patients with intrasella hemorrhage often have favorable prognosis after prompt evacuation of hematomas.The patients with suprasella hemorrhage, however, usually get a poor prognosis which indicates the prophylaxis is of great importance.