鼻内镜下切除垂体腺瘤术中脑脊液漏的分级及处理

Classification and treatment of cerebrospinal fluid leakage during resection of pituitary adenoma under nasal endoscopy

目的 介绍术中脑脊液漏的分级处理方法及带蒂鼻中隔黏膜瓣的使用。方法 回顾性分析2012年4月-2015年8月首都医科大学附属北京天坛医院神经外科九病房完成内镜切除垂体腺瘤手术的492例患者的临床资料,内容包括肿瘤的病理亚型、术中鞍膈破损情况、术中的修补方法、术后脑脊液漏、术后感染等并发症,所有患者均予3个月的严格随访。结果 本组86例患者发生术中脑脊液漏,其中Ⅰ级30例,Ⅱ级25例,Ⅲ级31例。术后脑脊液漏6例,分布在各个级别的患者中,3例经腰穿置管后漏液控制,3例再次手术修补。术后感染7例,均经抗炎治疗后好转。出院患者随访无脑脊液漏发生。结论 根据鞍膈破损程度进行分级,采用不同的重建方式进行修补,可有效避免术后及远期脑脊液漏的发生。

Objective To introduce the classification and treatment of intraoperative cerebrospinal fluid leakage and the use of pedicled septal mucosal flap. Methods A total of 492 cases of endoscopic resection of pituitary adenoma in the Ward No.9 of the Department of Neurosurgery in Beijing Tiantan hospital, Capital Medical University from April 2012 to August 2015 were retrospectively analyzed. Statistics included the pathological subtypes of the tumor, intraoperative saddle diaphragm damage, intraoperative repair methods, postoperative cerebrospinal fluid leakage, postoperative infections and other complications. All patients were given strict follow-up for 3 months. Results In this group of 86 patients with intraoperative cerebrospinal fluid leakage, 30 cases were in grade Ⅰ , 25 cases were in grade Ⅱ and 31 cases were in grade Ⅲ. Postoperative cerebrospinal fluid leakage was in 6 cases, distributed in all grades of patients. The leakage was controlled by lumbar puncture tube in 3 cases, and 3 cases were given surgical repair once again. Postoperative infection was in 7 cases, which were improved all by anti-inflammatory treatment. No cerebrospinal fluid leakage occurred in discharged patients during follow-up visit. Conclusion According to the severity of saddle diaphragm damage, different reconstruction methods should be used for repair, which can effectively avoid postoperative and long-term cerebrospinal fluid leakage,