内镜下经鼻蝶窦入路垂体瘤切除术后并发脑脊液漏的影响因素分析

Analysis of influencing factors of cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection

目的观察内镜下经鼻蝶窦入路垂体瘤切除术后并发脑脊液漏的影响因素,早期识别该并发症高风险病人。方法2019年5月~2022年10月我院神经外科行内镜下经鼻蝶窦入路垂体瘤切除术治疗的脑垂体瘤病人176例,统计术后脑脊液漏情况。应用单因素分析法筛选出病人术后并发脑脊液漏的可能影响因素,并行Logistic回归分析确定独立危险因素。结果176例脑垂体瘤病人术后并发脑脊液漏12例,发生率为6.82%。单因素分析显示,肿瘤直径、二次手术、术中脑脊液漏、术中脑脊液漏分级与病人术后并发脑脊液漏有关(P<0.05);Logistic回归分析显示,肿瘤直径(OR=3.843,95%CI=1.652~8.940)、二次手术(OR=2.407,95%CI=1.094~5.298)、术中脑脊液漏(OR=4.552,95%CI=1.483~13.972)、术中脑脊液漏分级(OR=3.516,95%CI=1.204~10.269)均为病人术后并发脑脊液漏独立危险因素(P<0.05)。结论肿瘤直径、二次手术、术中脑脊液漏、术中脑脊液漏分级与内镜下经鼻蝶窦入路垂体瘤切除术后并发脑脊液漏密切相关,应关注上述病人术中鞍底重建策略,加强观察术后脑脊液漏征象。

Objective To observe the influencing factors of cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,and promote the early identification of high-risk patients with this complication.Methods Retrospective analysis was made on the clinical data of 176 patients with pituitary adenoma who underwent endoscopic transsphenoidal pituitary adenoma resection in Department of Neurosurgery,Second Affiliated Hospital of Nanjing Medical University from May 2019 to October 2022,and the cerebrospinal fluid leakage after operation was counted.Single factor analysis was used to screen the possible influencing factors of postoperative cerebrospinal fluid leakage,and logistic regression analysis was used to determine the independent risk factors.Results 12 of 176 patients with pituitary adenoma had cerebrospinal fluid leakage after operation,the incidence was 6.82%(12/176).Univariate analysis showed that tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification were related to postoperative cerebrospinal fluid leakage(P<0.05).Logistic regression analysis showed that tumor diameter(OR=3.843,95%CI=1.652~8.940),reoperation(OR=2.407,95%CI=1.094~5.298),intraoperative cerebrospinal fluid leakage(OR=4.552,95%CI=1.483~13.972),and intraoperative cerebrospinal fluid leakage classification(OR=3.516,95%CI=1.204~10.269)were independent risk factors for postoperative cerebrospinal fluid leakage(P<0.05).Conclusion Tumor diameter,reoperation,intraoperative cerebrospinal fluid leakage,and intraoperative cerebrospinal fluid leakage classification are closely related to cerebrospinal fluid leakage after endoscopic transsphenoidal pituitary adenoma resection,we should pay close attention to the strategies of sellar floor reconstruction in the above patients,and strengthen the observation of the signs of cerebrospinal fluid leakage after surgery.