论文部分内容阅读
目的探讨大垂体腺瘤及巨大垂体腺瘤经蝶窦切除术中脑脊液漏的防治方法。方法回顾性分析2004年2月~2013年2月间23例大型垂体腺瘤经蝶窦切除术中并发脑脊液漏患者临床资料。结果 23例中损伤鞍隔颅底附着点11例,鞍隔皱褶破裂5例;蛛网膜破裂者4例;鞍底硬膜切口过高3例;均予鞍底修补重建,术后6例出现脑脊液鼻漏,经腰大池置管持续引流12~17 d后治愈,无二次鞍底修补者。出院随访5~18个月,无脑膜炎、脑脓肿等并发症出现。结论经蝶窦入路手术治疗大型垂体腺瘤应术前充分评估脑脊液漏发生可能,术中仔细操作,及时发现脑脊液漏并修补,对出现术后脑脊液鼻漏者腰大池置管持续引流,必要时二次手术治疗。
Objective To investigate the prevention and treatment of cerebrospinal fluid leakage in large pituitary adenomas and giant pituitary adenomas during transsphenoidal surgery. Methods The clinical data of 23 patients with large pituitary adenoma complicated with cerebrospinal fluid leakage during transsphenoidal sinus resection from February 2004 to February 2013 were analyzed retrospectively. Results In 23 cases, there were 11 cases of saddle skull base attachment points, 5 cases of rupture of folds of saddle, 4 cases of arachnoid rupture, 3 cases of saddle dural incision. Cerebrospinal fluid rhinorrhea occurred, by the lumbar cistern catheter drainage continued to be cured after 12 to 17 days, no secondary saddle repair. Follow-up of 5 to 18 months after discharge, no meningitis, brain abscess and other complications appear. CONCLUSIONS: Transsphenoidal approach for the treatment of large pituitary adenoma should be performed before surgery to fully evaluate the possibility of cerebrospinal fluid leakage. Careful operation during operation should be performed to detect and repair cerebrospinal fluid leakage in time. It is necessary to continue drainage of the lumbar cistern after cerebrospinal fluid leakage When the second surgery.