主动脉瓣机械瓣膜置换术后桥接抗凝下巨大无功能垂体腺瘤的手术治疗

Nonfunctional pituitary macroadenoma complicated with warfarin administration after mechanical aortic valve replacement operation:a case report and literature review

目的探讨心脏主动脉瓣机械瓣膜置换术后长期服用华法林抗凝后再接受颅脑手术的围手术期桥接抗凝策略。方法回顾性分析上海交通大学医学院附属瑞金医院2021年4月收治的1例心脏主动脉瓣机械瓣膜置换术后桥接抗凝的无功能垂体腺瘤患者的临床资料,并对相关文献进行复习。结果患者女,63岁,因轻微车祸外伤行头颅CT检查发现侵袭性垂体大腺瘤,拟行垂体腺瘤切除术;然而,术前常规检查发现主动脉瓣钙化伴重度狭窄,遂先行主动脉瓣机械瓣膜置换术,术后长期服用华法林抗凝。为改善视力视野,进一步行手术切除垂体大腺瘤,在多学科协作下采用神经内镜经鼻全切肿瘤,并对抗凝过程顺利进行桥接,患者术后无相关并发症。结论通过本病例的回顾分析,希望加强神经外科医师对颅脑手术合并心脏重大疾病的手术时机选择,以及抗凝过程中围手术期管理的认识,以期提高手术疗效及降低手术风险。

Objective To elucidate the neurosurgical preoperative bridging anticoagulation strategy for patients who take warfarin for a long time after the mechanical aortic valve replacement.Methods The clinical date of a nonfunctional pituitary macroadenoma patient admitted to Ruijin Hospital,Shanghai Jiao Tong University School of Medicine in April 2021 who underwent the preoperative bridging anticoagulation treatment due to the mechanical aortic valve replacement operation and warfarin administration history were analyzed retrospectively.Moreover,the relevant literature was reviewed.Results A 63-year-old female was diagnosed with the invasive nonfunctional pituitary adenoma by the head CT examination due to a minor car accident injury.Thus,the subsequent pituitary adenoma resection was planned.However,the preoperative routine examination revealed that the patient had the aortic valve calcification with severe stenosis.Given that,the mechanical aortic valve replacement was performed,followed by the long-term anticoagulation therapy with warfarin.In order to improve visual field and further perform surgical resection of pituitary macroadenomas,a multidisciplinary collaborative approach was used to remove the tumor through nasal endoscopy,and the anticoagulation process was smoothly bridged.The patient had no postoperative complications.Conclusions Through the retrospective analysis of this case,it is hoped that neurosurgeons can enhance their understanding of the timing of craniocerebral surgery combined with major heart diseases,as well as perioperative management during anticoagulation,in order to improve surgical efficacy and reduce surgical risks.