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目的探讨在经颅垂体瘤手术中使用钛夹、人工脑膜等材料进行的修复切口及缺损鞍隔重建价值及意义。方法对我院38例经颅垂体瘤手术中进行鞍隔缺损程度分级并进行鞍隔修复重建,切除肿瘤后使用钛夹、人工脑膜、医用耳脑胶对鞍隔进行一期修复、重建,对照组为未进行鞍隔重建的74例患者,比较两组患者的围手术期及远期并发症和预后情况。结果随访14~46个月,鞍隔重建组中,1例患者术后3 h CT显示鞍区未压迫视神经的小血肿,均未发生脑脊液漏、颅内感染、空蝶鞍综合征及其他并发症。鞍隔未重建组中,1例术后1 h因鞍区出血出现进行性视力下降及意识障碍并再次开颅手术,空蝶鞍发生率及需二期经蝶手术患者的脑脊液漏、颅内感染的发生率高于鞍隔重建组(P<0.05),但两组的尿崩症发生率及垂体功能、视力恢复情况差异无统计学意义(P>0.05)。结论经颅垂体瘤手术中依据鞍区的解剖生理状态进行鞍隔修复重建非常必要,钛夹、人工脑膜、耳脑胶在其中具有新的应用价值,可显著减少术后因鞍区出血需再次手术、空蝶鞍、二期经蝶手术脑脊液漏和颅内感染的发生率,此技术具有推广价值。
Objective To investigate the value and significance of repair incision and saddle reconstruction with titanium clips and artificial meninges during transcranial pituitary tumor surgery. Methods 38 cases of transcranial pituitary tumor in our hospital for the degree of septal defect and saddle to repair and reconstruction, removal of the tumor after the use of titanium clips, artificial meninges, medial ear glue on the septum of a repair, reconstruction, control Group 74 patients without saddle reconstruction, the perioperative and long-term complications and prognosis were compared between the two groups. Results All the patients were followed up for 14 to 46 months. One case of post-operative reconstruction of the septum showed no cerebrospinal fluid leakage, intracranial infection, empty sella syndrome and other complications disease. One case of postoperative one hour after operation due to saddle zone hemorrhage occurred progressive visual loss and unconsciousness and re-craniotomy, the incidence of empty sella and cerebrospinal fluid leakage in patients with transsphenoidal surgery, intracranial The incidence of infection was higher than that in the septum reconstruction group (P <0.05). However, the incidence of diabetes insipidus and the pituitary function and visual acuity recovery in both groups showed no significant difference (P> 0.05). Conclusion It is necessary to repair and reconstruct the saddle by anatomical and physiological status of the transscleral pituitary tumor. Titanium clips, artificial meninges and ear glue have new application value in it, which can significantly reduce the postoperative bleeding due to the sellar area Surgery, empty sella, second transsphenoidal surgery cerebrospinal fluid leakage and intracranial infection, the technology has the promotion value.