神经内镜下经鼻蝶垂体腺瘤切除术中鞍底支撑

Comparison between two bolstering materials in endoscopic endonasal transsphenoidal surgery for pituitary adenoma

目的探讨神经内镜下经鼻蝶入路切除垂体腺瘤时颅底重建时不同鞍底支撑物的临床特点分析。方法选取2017年1月至2017年9月在陆军军医大学第三附属医院神经外科行经神经内镜经鼻蝶手术治疗的50例垂体腺瘤患者为研究对象,术前两组患者的性别、年龄、肿瘤大小和内分泌功能对比差异无统计学意义(P> 0. 05)。切除肿瘤过程中采取双鼻孔经鼻蝶窦入路内镜下操作技术,结合4B暴露技术和"假包膜外切除"技术,根据颅底重建时采用鞍底支撑物的不同,随机分为纳吸绵支撑组和纱条支撑组各25例。结果两组患者术后严重并发症总发生率无统计学差异,术后纳吸绵支撑组无需拔除填塞物,但需在门诊行鼻腔清理;纱条支撑组5 d左右拔除鼻腔填塞物。鼻部舒适度评估:纳吸绵支撑组优于纱条支撑组,差异有统计学意义(P <0. 05)。结论蝶窦脂肪+纳吸绵填塞以及碘仿纱条填塞,两种鞍底支撑物在术后早期可抵抗来自于鞍底腹侧脑脊液搏动等对颅底薄弱重建物的冲击,均是重要的鞍底重建辅助技术。但碘仿纱条填塞作为支撑物会增加患者不适感,应根据具体情况来选择不同鞍底支撑材料。

Objective The clinical characteristics of different saddle bottom support in the reconstruction of the skull base during transsphenoidal transsphenoidal resection of pituitary adenomas under endoscopically transsphenoidal approach was discussed. Methods The clinical characteristics of different saddle bottom bolster in the reconstruction of the skull base during endoscopic transsphenoidal transsphenoidal resection of pituitary adenomas were discussed. A total of 50 patients with pituitary adenoma who underwent neuroendoscopic microsurgical operations using bilateral endonasal combined with 4 B technology at Department of Neurosurgery,Third Affiliated Hospital of Army Medical University from January2017 to September 2017 were studied. There was no statistical significance in gender,age,tumor size and endocrine function between two groups of patients compared to pre-operation（P〉0. 05）. According to different saddle bottom support in the reconstruction of the skull base,all the patients were randomly divided into the Naso Pore support group（25 cases） and the yarn bar support group（25 cases）. Results There was no statistical difference in the total incidence of post-operative complications between the two groups. In Naso Pore support group,there was no need to remove the stuffing,but the nasal cleaning was needed in the outpatient department. In yarn bar support group,the nasal stuffing was extracted for about 5 d. The degree of comfort in Naso Pore support group was better than that of the yarn bar support group,with statistically significant difference（P〈0. 05）. Conclusion Both types of saddle bolstering can resist the shock of the skull base from the ventral cerebrospinal fluid during the early post-operative period. However,iodoform gauze packing as a bolstering will increase the patient discomfort,so the choice of treatment should be made based on the specific circumstances.