鼻中隔黏膜瓣修复鞍区垂体Rathke囊肿手术创面疗效观察

Clinical effect of nasal septum mucosal flap in repairing the surgical wounds of pituitary Rathke's cleft cyst in sellar area

目的观察应用鼻中隔黏膜瓣修复鞍区垂体Rathke囊肿手术创面的临床疗效。方法回顾性分析2020年1月至2021年4月在天门市第一人民医院耳鼻咽喉头颈外科经鼻蝶窦入路切除鞍区垂体Rathke囊肿手术的5例患者的临床资料,术中应用鼻中隔黏膜瓣修补鞍区垂体Rathke囊肿手术创面。结果5例患者中,1例术后出现头疼,但较术前减轻;1例术后出现短暂性尿崩症合并电解质紊乱,术后积极补液,予以醋酸去氨加压素治疗,积极治疗后好转出院;1例术后出现短暂脑脊液鼻漏,采取保守治疗后治愈。5例患者愈合良好,无视力障碍及颅内出血等严重并发症出现,出院后门诊随访行内镜检查,鼻中隔黏膜瓣愈合良好,未出现黏膜瓣坏死等并发症,术后随访6~15个月未见复发。结论鼻中隔黏膜瓣具有血运丰富、较易成活等优点,临床取材操作简便,可用于鞍区垂体Rathke囊肿切除手术创面后术区修补。

Objective To explore the clinical effect of using nasal septum mucosal flap to repair the surgical wounds of pituitary Rathke's cleft cyst in sellar area.Methods The clinical data of 5 patients undergoing surgery of pituitary Rathke's cleft cyst in the sellar area via nasal sphenoid sinus approach in Department of Otolaryngology,Head and Neck Surgery,Tianmen First People's Hospital from January 2020 to April 2021 were analyzed retrospectively.The nasal septum mucosal flap was used to repair the surgical wounds of the pituitary Rathke's cleft cyst in the sellar area.Results Among the five patients,one had relieved headache after operation;one developed transient diabetes insipidus with electrolyte disorder after operation,which was improved and discharged after active rehydration and desmopressin acetate treatment;one had transient cerebrospinal fluid rhinorrhea after operation,which was cured after conservative treatment.Five patients healed well without serious complications such as visual impairment and intracranial hemorrhage.During the follow-up,endoscopic examination was performed in the Outpatient Department after discharge.The nasal septum mucosal flap healed well without complications such as mucosal flap necrosis.No recurrence was found during the follow-up of 6-15 months.Conclusion Nasal septum mucosal flap has the advantages of rich blood supply and easy to survive,and it is easy to obtain materials and operate clinically,which can be used for repairing the surgical wound after resection of pituitary Rathke's cleft cyst in sellar area.