游离中鼻甲粘膜瓣在经鼻蝶入路神经内镜手术切除垂体腺瘤后鞍底重建中的应用

Application of free middle turbinate mucosal flaps to reconstruction of sellar floors in endoscopic transnasal transsphenoidal surgery in patients with pituitary adenomas

目的探讨游离中鼻甲粘膜瓣在经鼻蝶入路神经内镜手术治疗垂体腺瘤鞍底重建中的方法及应用价值。方法回顾性分析2017年6月至2018年6月经鼻蝶入路神经内镜手术治疗的45例直径1~2.5 cm的垂体腺瘤的临床资料。经单鼻孔手术25例(单鼻孔组),双鼻孔手术20例(双鼻孔组)。术中均采用游离中鼻甲粘膜瓣重建鞍底。结果肿瘤均全切除。术后随访6个月,两组均未出现脑脊液漏和颅内感染,均无鼻腔干燥、异味等鼻部并发症;单鼻孔组术后嗅觉障碍发生率(16.0%,4/25)明显低于双鼻孔组(90.00%,18/20;P<0.05)。结论对于直径1~2.5 cm的垂体腺瘤,经鼻蝶入路神经内镜手术中鞍底缺损直径约2 cm,采用游离中鼻甲粘膜瓣进行鞍底重建,可有效预防脑脊液漏、颅内感染,单鼻孔组术后嗅觉障碍发生率较双鼻孔组低。

Objective To explore the method to reconstruct the sellar floors with free middle turbinate mucosal flaps in the endoscopic transnasal sphenoidal surgery and its value in the patients with pituitary adenomas. Methods The clinical data of 45 patines with pituitary adenomas 1~2.5 cm in diameter treated by endoscopic transsphenoidal surgery from June, 2017 to June, 2018 were analyzed retrospectively. Of these 45 patients, 25 underwent endoscopic transsphenoidal surgery through single nostril approach(single nostril group) and 20 through double nostrils approach(double nostrils group). The sellar floors were intraoperatively reconstructed with free middle turbinate mucosal flaps in all the patients. Results The following-up 6 months after the operation showed that there were no complications such as cerebrospinal fluid(CSF) leakage and intracranial infection, dry nasal cavity and abnormal odor. The rate of olfactory hypoesthesia(16%, 4/25) was significantly lower in the single nostril group than that(90%, 18/20) in the double nostrils group(P<0.05). Conclusions The reconstruction of the sellar floors with free middle turbinate mucosal flaps is an effective and safe method to prevent the postoperative complications such as CSF leakage and intracranial infection in the patients with pituitary adenomas 1~2.5 cm in diameter and sellar floor defect some 2 cm in diameter. The patients with pituitary adenomas undergoing endoscopic transsphenoidal surgery through the single nostril approach have significantly low incidence of postoperative olfactory hypoesthesia compared with the patients through the double nostrils approach.