神经内镜下经鼻蝶垂体腺瘤切除术后并发症的防治

Study on the causes,prevention and treatment of complications after transsphenoidal pituitary tumor resection under neuroendoscope

目的分析神经内镜下经鼻蝶垂体腺瘤切除术后并发症的原因,同时总结相应的防治措施。方法对2018年1月至12月新乡医学院附属新乡市中心医院神经外科收治的120例垂体腺瘤患者的病理学资料等进行回顾性分析,所有患者均行手术治疗,采集5种常见术后并发症,对并发症发生的危险因素进行统计分析,明确术后并发症原因,总结出具体的防治策略。结果手术时间长(P<0.05)、术前垂体功能低下(P<0.01)和大肿瘤(P<0.01)3项指标属于术后脑脊液鼻漏的主要诱发因素;手术时间长(OR=1.394,P<0.01)、术后腰大池穿刺置管(OR=1.531,P<0.01)及术后脑脊液鼻漏(OR=3.861,P<0.01)3项指标属于感染发生的独立性危险因素;患者年龄、大肿瘤以及术前垂体功能低下几项指标属于术后垂体功能低下的主要因素;术后垂体功能低下与术中脑脊液鼻漏指标属于术后尿崩发生的主要因素;术后垂体功能低下属于术后低钠血症发生的主要因素。结论神经内镜下经鼻蝶垂体腺瘤切除术,在目前是最微创的方法,仍存在发生手术后并发症危险因素,针对性防范并发症危险因素,并实施对应的干预措施,可有效降低术后并发症发生率。

Objective To analyze the causes of complications after endoscopic transsphenoidal pituitary adenoma resection and summarize the corresponding prevention and treatment measures.Methods The pathological data of 120 patients with pituitary adenoma in hospital were analyzed retrospectively.All patients were treated surgically,five kinds of common complications were collected,the risk factors of complications were statistically analyzed,the causes of postoperative complications were determined,and then the specific prevention and treatment strategies were summarized.Results Long operation time(P<0.05),hypopituitarism before operation(P<0.01)and large tumor(P<0.01)were the main inducing factors of CSF rhinorrhea after operation;long operation time(OR=1.394,P<0.01),lumbar cistern puncture(OR=1.531,P<0.01)and CSF rhinorrhea after operation(OR=3.861,P<0.01)were the independent risk factors of infection;Age,large tumor and preoperative hypophysis are the main factors of postoperative hypophysis;Postoperative hypophysis and intraoperative cerebrospinal fluid rhinorrhea are the main factors of postoperative diabetes insipidus;Postoperative hypophysis and giant adenoma are the main factors of postoperative hyponatremia.Conclusion Endoscopic transnasal transsphenoidal resection of pituitary adenoma is the most minimally invasive method at present.There are still risk factors for postoperative complications.Targeted prevention of risk factors for complications and corresponding interventions can effectively reduce the incidence of postoperative complications of pituitary adenoma.