神经内镜下经鼻蝶窦切除垂体腺瘤术后并发症的观察

Postoperative complications of endoscopic transsphenoidal pituitary adenoma resection

目的探讨神经内镜下经鼻蝶窦切除垂体腺瘤常见的并发症及其防治措施。方法回顾性分析2014年1月至2016年6月于郑州大学第一附属医院神经外科行神经内镜下经鼻蝶窦切除垂体瘤的患者175例。术后随访3～24个月，观察并发症的发生情况。结果175例患者中，肿瘤全切除86.8%（152例）、次全切除10.3%（18例）、部分切除2.9%（5例）。术后短暂视力下降1.1%（2例），分别由血肿和填塞物压迫视神经引起；术后垂体功能减退11.4%（20例），短暂性尿崩22.3%（39例），脑脊液漏4.0%（7例），颅内感染1.7%（3例），永久性嗅觉丧失1.1%（2例）,蝶窦囊肿0.6%（1例）。71例术中出现脑脊液漏者，6例（8.5%）术后出现脑脊液漏；104例术中未发生脑脊液漏患者中，1例（1.0%）术后出现脑脊液漏，差异有统计学意义（P＝0.037）。肿瘤复发二次手术者，术后3例（3/9）出现脑脊液漏；166例首次手术者中，术后4例（2.4%）出现脑脊液漏，差异有统计学意义（P＝0.000）。无死亡病例。结论神经内镜下经鼻蝶窦手术切除垂体腺瘤并发症的发生率相对较低，多数可以防治。

Objective To analyze preventive measures and therapeutic methods of postoperative complications of endoscopic transsphenoidal pituitary adenoma resection. Methods A retrospective analysis was conducted on 175 cases of endoscopic transsphenoidal resections of pituitary adenoma between January 2014 and June 2016 at Neurosurgery Department of the First Affiliated Hospital of Zhengzhou University. A follow-up was performed on all cases at 3 to 24 months post surgery to observe postoperative complications. Results Among the 175 cases of endoscopic transsphenoidal resection of pituitary adenoma, gross total resection was achieved in 152 patients （86.8 % ）, subtotal resection in 18 patients （ 10.3 % ）, and partial resection in 5 patients （2.9 % ）. Complications included 2 （ 1. 1% ） cases of transient postoperative visual worsening due to compression of the optic nerve by hematoma in 1 case and tamponade in the other, 20 （ 11.4% ） cases of postoperative pituitary dysfunction, 39 （22.3 % ） cases of transient diabetes insipidus, 7 （ 4.0 % ） cases of cerebrospinal fluid rhinorrhea, 3 （ 1.7% ） cases of intracranial infection, 2 （1.1%） cases of permanent loss of smell and 1 （0.6%） case of sphenoid sinus cyst. Intraoperative and postoperative cerebrospinal fluid leakage occurred in 71 cases and 6 cases （8.5%）, respectively. Among the 104 patients without cerebrospinal fluid leakage during surgery, 1 case （1.0%） developed cerebrospinal fluid leakage post operation, and the difference was statistically significant （P = 0. 037）. Out of 9 cases of tumor recurrence undergoing secondary surgery, 3 cases developed postoperative cerebrospinal fluid leakage. Among the 166 cases undergoing one operation, the cerebrospinal fluid leakage occurred in 4 （2.4%） cases, and the difference was statistically significant （P = 0. 000）. There was no death in this series. Conclusion Endoscopic transsphenoidal resection of pituitary adenoma seems to have relatively low incidence of complications and their majority could be prevented.