脂肪填塞对神经内镜经蝶垂体腺瘤切除术中脑脊液漏的疗效分析

Effect of fat tamponade on cerebrospinal fluid leakage during endoscopic transsphenoidal pituitary adenoma resection

目的探讨神经内镜经蝶垂体腺瘤切除术中发生脑脊液漏时,脂肪填塞在进行鞍底重建中的作用。方法选取河北省人民医院神经外科2016年6月至2021年6月收治的96例行经鼻蝶神经内镜下切除垂体腺瘤术中并发脑脊液漏患者的临床资料采用历史性对照研究分析,根据患者手术时间及方法进行分组,其中观察组48例均于2019年及之后手术治疗,并采用脂肪填塞+明胶海绵+人工硬膜+鼻中隔黏膜瓣修复鞍底,其中脑脊液漏1级37例,脑脊液漏2级11例;对照组48例均于2019年之前进行手术治疗,采用明胶海绵+人工硬膜+鼻中隔粘膜瓣修复鞍底,其中脑脊液漏1级41例,脑脊液漏2级7例。根据患者术后及随访过程中脑脊液漏发生率,比较2组手术有效率,并进行随访15~26个月。结果术后观察组脑脊液漏整体发生率4.1%(2/48),其中脑脊液漏1级术后持续漏发生率2.7%(1/37),脑脊液漏2级术后持续漏发生率9.1%(1/11)。对照组整体发生率为16.7%(8/48),其中脑脊液漏1级术后持续漏发生率7.3%(3/41),脑脊液漏2级术后持续漏发生率71.4%(5/7)。2组术后脑脊液漏整体发生率差异均有统计学意义(P<0.05)。结论脂肪填塞在鞍底重建中具有重要作用,尤其对于术中即发生脑脊液漏2、3级患者,可有效降低术后脑脊液漏发生率,但对术中发生脑脊液漏1级患者,脂肪填塞重建鞍底是否仍具有显著效果需进一步研究。

Objective To investigate the role of fat tamponade in sellar floor reconstruction during endoscopic transsphenoidal pituitary adenoma resection.Methods From June 2016 to June 2021,clinical data of 96 patients with cerebrospinal fluid(CSF)leakage during endoscopic transsphenoidal pituitary adenoma resection admitted to the Department of Neurosurgery of Hebei General Hospital were collected for historical control study.According to the time of surgery and surgical procedures,48 patients surgically treated after 2019 were included in the observation group,and they were managed by sellar floor reconstruction using fat tamponade,gelatin sponge,artificial dura mater suturing and nasoseptal flap technique.In the observation group,there were 37 and 11 cases of type 1 and type 2 CSF leakage,respectively.Another 48 patients surgically treated before 2019 were included in the control group,and they were managed by sellar floor reconstruction using gelatin sponge,artificial dura mater suturing and nasoseptal flap technique.In the control group,there were 41 and 7 cases of type 1 and type 2 CSF leakage,respectively.The surgery effective rate was compared between groups based on the incidence of CSF leakage postoperatively and during the follow-up period for 15-26 months.Results The overall incidence of CSF leakage in the observation group was 4.1%(2/48),and the incidence of continuous type 1 and 2 CSF leakage postoperatively was 2.7%(1/37)and 9.1%(1/11),respectively.The overall incidence of CSF leakage in the control group was 16.7%(8/48),and the incidence of continuous type 1 and 2 CSF leakage postoperatively was 7.3%(3/41)and 71.4%(5/7),respectively.There was a significant difference in the overall incidence of CSF leakage between groups(P<0.05).Conclusion Fat tamponade plays an important role in sellar floor reconstruction,especially for patients with intraoperative type 2-3 CSF leakage.It effectively lowers the incidence of postoperative CSF leakage.However,the efficacy of fat tamponade during sellar floor reconstruction in patients with intraoperative type 1 CSF leakage needs to be further analyzed.