内镜下经鼻蝶垂体瘤切除术后脑脊液漏的危险因素分析

Analysis of risk factors related to cerebrospinal fluid fistulas due to endoscopic transnasal surgery for pituitary adenoma

目的研究内镜下经鼻蝶垂体瘤切除术(ETS)后发生脑脊液漏的危险因素。方法回顾性分析了徐州医科大学附属医院神经外科2016年1月—2018年12月,行内镜下经鼻蝶垂体瘤切除术的194例患者的临床资料。其中术后出现脑脊液漏者25例,未出现脑脊液漏者169例。比较术后脑脊液漏组与未出现脑脊液漏组患者的临床资料;用多因素Logistic回归分析术后发生脑脊液漏的危险因素。结果术后脑脊液漏组和未出现脑脊液漏组患者的肿瘤大小比较,差异有统计学意义(P<0.001)。术后脑脊液漏组患者术中出现脑脊液漏、肿瘤质韧、肿瘤部分切除的比例明显高于未出现脑脊液漏组,差异均有统计学意义(均P<0.001)。多因素Logistic回归分析显示巨大腺瘤、术中脑脊液漏、肿瘤质韧是术后发生脑脊液漏的独立危险因素。结论内镜下经鼻蝶垂体瘤切除术后脑脊液漏的危险因素为巨大腺瘤、术中发生脑脊液漏及肿瘤质韧。

Objective To investigate the risk factors of cerebrospinal fluid(CSF)leak due to endoscopic transnasal surgery for pituitary adenoma.Methods The clinical data of 194 patients with pituitary adenoma underwent endoscopic transsphenoidal surgery(ETS)from January 2016 to December 2018 in the Department of Neurosurgery,Xuzhou Medical University Hospital,were analyzed retrospectively.Of 194 patients,there were 25 with postoperative CSF leak and 169 without CSF leak.The clinical data were compared between the patients with and without post-operative CSF leak.Multivariate logistic regression analysis was performed to analyze the independent risk factors for post-operative CSF leak.Results There was a statistically significant difference in tumor size between the patients with and without post-operative CSF leak(P<0.001).The incidence of intra-operative CSF leak,tumor toughness,and partial tumor resection in the patients with post-operative CSF leak were apparently higher than those without post-operative CSF leak(P<0.001).Multivariate logistic regression analysis showed that giant adenoma,intra-operative CSF leak,and tumor toughness were independent risk factors for post-operative CSF leak.Conclusion In endoscopic transnasal surgery for pituitary neoplasms,the risk factors for post-operative CSF leak are giant pituitary neoplasms,intra-operative CSF leak and tumor toughness.