鼻内打结硬膜缝合技术在神经内镜经鼻颅底重建中的应用

Clinical application of intranasal knotting for dural suturing in endoscopic transnasal skull base reconstruction

目的观察神经内镜经鼻颅底重建术中应用鼻内打结硬膜缝合技术的安全性、有效性及缝合效率。方法纳入44例2018年11月至2021年1月于空军军医大学唐都医院神经外科行神经内镜经鼻手术并于术中采用鼻内打结硬膜缝合技术进行颅底重建的患者,术中均应用2把上弯持针器行鼻内打结,其中13例应用万向笔式弯显微针持加枪式固定方向弯针持打结(初始组),31例应用2把万向笔式弯显微针持打结(改良组)。回顾性分析术后脑脊液漏、与缝合相关的血管和神经损伤的发生率,评估鼻内打结硬膜缝合技术的有效性和安全性;比较两种打结方式的安全性、有效性及打结效率的差异。结果44例患者中,1例(2.3%)术后发生脑脊液漏,为初始组患者;无一例患者发生与缝合相关的血管和神经损伤。两组术后脑脊液漏的发生比例差异无统计学意义(P>0.05)。改良组与初始组的每针缝合时间分别为(5.6±1.7)min、(10.8±4.7)min,每针抓取次数分别为(21.0±6.0)次、(45.4±20.6)次,差异均有统计学意义(均P<0.001);而抓取准确率分别为(90.3±4.9)%、(88.0±3.4)%,差异无统计学意义(P=0.121)。结论在神经内镜经鼻颅底重建术中采用鼻内打结硬膜缝合技术安全、有效,其中应用2把万向笔式弯显微针持打结方式的效果优于万向笔式弯显微针持加枪式固定方向弯针持打结方式。

Objective To investigate the safety,effectiveness and efficiency of intranasal knotting for dural suturing during skull base reconstruction through endoscopic transnasal approach.Methods This study enrolled a total of 44 patients who underwent neuroendoscopic transnasal surgery involving intranasal knotting for dural suturing during skull base reconstruction at the Department of Neurosurgery,Tangdu Hospital of Air Force Military Medical University from November 2018 to January 2021.Two curved needle holders were used for intranasal knotting in all cases.Among them,rotatable angled microscopic needle holders and non-rotatable angled bayonet needle holders(initial group)were used in 13 cases;double rotatable angled microscopic needle holders were used in 31 cases(improved group).We retrospectively analyzed the incidence of postoperative cerebrospinal fluid leakage and suturing-related vascular and nerve damage,evaluated the effectiveness and safety of intranasal knotting for dural suturing,compared the differences in the safety,effectiveness and efficiencies of the two knotting methods.Results Among the 44 patients,1 case(2.3%)had postoperative cerebrospinal fluid leakage,which was in the initial group of patients.None of the patients had suturing-related vascular or nerve damage.There was no significant difference in the incidence of postoperative cerebrospinal fluid leakage between the two groups(P>0.05).The suturing time per stitch of the patients in the improved group and the initial group was 5.6±1.7 min and 10.8±4.7 min,respectively,the number of grasping times per stitch was 21.0±6.0 and 45.4±20.6,respectively,and both differences were statistically significant(both P<0.001).The grasping accuracy rates were 90.3±4.9%and 88.0±3.4%,respectively,and the difference was not statistically significant(P=0.121).Conclusions The intranasal knotting for dural suturing used in neuroendoscopic transnasal skull base reconstruction is safe and effective.Moreover,the effect of intranasal knotting using double rotatable angled microscopic needle holder is better than that using a rotatable angled microscopic needle holder and a non-rotatable angled bayonet needle holder.