内镜下经鼻蝶窦入路手术治疗垂体瘤术后继发颅内感染的危险因素研究

Study on the Risk Factors of Secondary Intracranial Infection after Endoscopic Transsphenoidal Approach in the Treatment of Hypophysoma

目的:探讨内镜下经鼻蝶窦入路术后颅内感染(ICI)发生的危险因素。方法:回顾性分析2007年4月-2017年4月本院收治的垂体瘤患者368例的临床资料。分析患者术后ICI发生率,并根据是否发生ICI将其分为ICI组、非ICI组,收集两组临床资料,分析术后ICI发生的独立危险因素。结果:本研究368例患者中,发生ICI 31例(8.42%),未发生ICI 337例(91.58%);ICI组术后脑脊液漏、术后未使用抗生素、术后使用激素、再次手术的占比分别为29.03%、32.26%、77.42%、29.03%,均高于非ICI组的6.82%、13.65%、42.73%、9.50%,比较差异均有统计学意义(P<0.05);经COX回归性分析发现,术后脑脊液漏、术后使用激素、再次手术是垂体瘤术后ICI的独立危险因素(P<0.05),而术后及时使用抗生素是预防ICI的保护因素(P<0.05)。结论:内镜下经鼻蝶窦入路垂体瘤切除术后ICI的发生与术后脑脊液漏、术后使用激素、再次手术相关,而术后使用抗生素能降低ICI风险。

Objective：To investigate the risk factors for the occurrence of intracranial infection（ICI） after endoscopic transsphenoidal approach.Method：The clinical data of 368 patients with hypophysoma admitted to our hospital from April 2007 to April 2017 were retrospectively analyzed.The incidence of ICI after operation was analyzed.According to the occurrence of ICI,they were divided into ICI group and non ICI group,and two groups of clinical data were collected,and the independent risk factors of ICI after operation were analyzed.Result：Among the 368 patients,31 cases（8.42%） developed ICI,and 337 cases（91.58%） did not developed ICI.Cerebrospinal fluid leakage,postoperative antibiotics,postoperative use of hormone and reoperation in ICI group were 29.03%,32.26%,77.42% and 29.03% respectively,which were all higher than 6.82%,13.65%,42.73% and 9.50% in non ICI group,the differences were statistically significant（P〈0.05）.COX regression analysis showed that postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation were independent risk factors for ICI after hypophysoma surgery（P〈0.05）,and the timely use of antibiotics was a protective factor to prevent ICI（P〈0.05）.Conclusion：The incidence of ICI after endoscopic endonasal transsphenoidal approach is related to postoperative cerebrospinal fluid leakage,postoperative use of hormone and reoperation,whilepostoperative antibiotic use can reduce ICI risk.