摘要
目的探讨神经内镜经鼻垂体神经内分泌肿瘤(PitNET)切除术中应用双侧后隔黏膜瓣进行颅底重建的可靠性和安全性。方法回顾性分析2021年1月至2022年6月于山东大学齐鲁医院神经外科行神经内镜经鼻PitNET切除术的161例患者的临床资料。采用双侧后隔黏膜瓣进行颅底重建者77例(简称黏膜瓣组),采用移植物行颅底重建者84例(简称移植物重建组)。应用前颅底鼻腔调查问卷和嗅觉的视觉模拟量表评分评估患者的生存质量。比较两组患者的基线特征、手术及住院时长、术后脑脊液漏和其他术后并发症的发生情况,以及生存质量方面的差异。结果黏膜瓣组与移植物重建组患者在基线特征方面的差异均无统计学意义(均P>0.05)。黏膜瓣组中,1例(1.3%)患者术后发生脑脊液漏;移植物重建组中,10例(11.9%)出现脑脊液漏,两组的差异具有统计学意义(t=1.04,P=0.307)。所有患者均完成随访,随访时间为6~24个月。两组患者在手术及住院时长、除脑脊液漏外的其他术后并发症的发生率、前颅底鼻腔调查问卷和嗅觉的视觉模拟量表评分方面的差异均无统计学意义(均P>0.05)。结论应用双侧后隔黏膜瓣是一种可靠的颅底重建方法,能有效降低PitNET术后脑脊液漏的发生率,且对患者的手术及住院时长、其他并发症的发生率和生存质量无明显不利影响。
Objective To investigate the reliability and safety of using bilateral posterior nasoseptal flaps for skull base reconstruction during endoscopic transnasal resection of pituitary neuroendocrine tumors(PitNET).Methods We retrospectively analyzed the clinical data of 161 patients who underwent endoscopic transnasal resection of PitNET at the Department of Neurosurgery,Qilu Hospital of Shandong University from January 2021 to June 2022.The patients were divided into the bilateral posterior nasoseptal mucosal flap group(mucosal flap group,n=77)and conventional free graft multiple skull base reconstruction group(free graft group,n=84).The patient′s life quality was evaluated using the Anterior Skull Base Nasal Inventory-12(ASK Nasal-12)and Visual Analogue Scale(VAS).The differences in baseline characteristics,operation time,hospitalization stay,postoperative cerebrospinal fluid(CSF)leakage and other postoperative complications,and life quality were compared between the two groups.Results There were no significant differences in baseline characteristics between the two groups(all P>0.05).One case(1.3%)in the mucosal flap group had postoperative CSF leakage,10 cases(11.9%)in the free graft group had CSF leakage,and the difference was statistically significant(t=1.04,P=0.307).All patients completed follow-up which ranged from 6 to 24 months.There were no significant differences in operation time,hospitalization stay,incidences of postoperative complications except CSF,ASK Nasal-12 or VAS score between the two groups(all P>0.05).Conclusion Application of bilateral posterior nasoseptal flaps is a reliable technique of skull base reconstruction that can effectively reduce the incidence of postoperative CSF leakage without significant adverse effects on the duration of surgery and hospitalization,complication rates,or quality of life of PitNET patients.
作者
仲瀚林
颜明布
戚其超
杨晨
倪石磊
Zhong Hanlin;Yan Mingbu;Qi Qichao;Yang Chen;Ni Shilei(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Neurosurgery,Weihai Central Hospital,Weihai 264400,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2023年第12期1216-1221,共6页
Chinese Journal of Neurosurgery
关键词
自然腔道内镜手术
垂体肿瘤
治疗结果
鼻中隔黏膜瓣
颅底重建
Natural orifice endoscopic surgery
Pituitary neoplasms
Treatment outcome
Nasoseptal flap
Skull base reconstruction