改良带蒂鼻中隔黏膜瓣在经蝶垂体瘤手术脑脊液漏中的应用

Application of modified pedicled nasal septum mucosa flap on cerebrospinal fluid leakage in transsphenoidal pituitary surgery

目的探讨改良带蒂鼻中隔黏膜瓣在经鼻蝶入路垂体瘤切除术脑脊液漏中的应用疗效。方法回顾性分析2017年8月至2018年12月大连医科大学附属大连市中心医院行神经内镜经鼻蝶入路垂体瘤切除术中应用改良带蒂鼻中隔黏膜瓣28例患者的临床资料。术中出现高流量脑脊液漏7例,采用改良带蒂鼻中隔黏膜瓣进行鞍底重建。其余21例将黏膜瓣复位。结果7例改良带蒂鼻中隔黏膜瓣鞍底重建患者术后无脑脊液鼻漏,嗅觉减退1例。21例黏膜瓣复位患者术后脑脊液漏1例,腰大池持续引流8 d后脑脊液漏停止;嗅觉减退1例。结论改良带蒂鼻中隔黏膜瓣是一种安全可靠的黏膜瓣技术,既可以达到带蒂鼻中隔黏膜瓣修补鞍底的效果,还能避免黏膜瓣过度应用导致的鼻腔并发症。

Objective To explore the therapeutic effect of modified pedicled nasal septum mucosa flap on cerebrospinal fluid leakage in transsphenoidal pituitary surgery.Methods The clinical data of 28 patients treated with modified pedicled nasal septal mucosa flap during endoscopic transsphenoidal resection of pituitary adenoma in Dalian Central Hospital from August 2017 to December 2018 were analyzed retrospectively.Seven cases of high-flow cerebrospinal fluid leakage occurred during the operation.Skull base reconstruction was performed with modified pedicled nasal septum mucosal flap.Modified pedicled nasal septum mucosal flap was repositioned in 21 cases.Results Seven cases of modified pedicled nasal septum mucosal flap for skull base reconstruction had no postoperative cerebrospinal fluid leakage and 1 case had hypoolusia.Postoperative cerebrospinal fluid leakage occurred in One of the 21 patients with mucosal flap replacement,and stopped after 8 d of continuous lumbar drainage.One case had hypoolusia.Conclusions Modified pedicled nasal septum mucosal flap is a safe and reliable technique.It can not only achieve the effect of pedicled nasal septum mucosal flap in skull base reconstruction,but also avoid nasal complications caused by excessive application of mucosal flap.