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目的:探讨巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病原因,并提出相关的修补措施。方法:选择2009年2月-2012年8月在我院进行诊治的巨大垂体腺瘤患者180例,所有患者均采用经蝶手术摘除巨大垂体腺瘤。观察预后情况。结果:在接受经蝶手术的180例患者中,25例发生脑脊液鼻漏,发生率为13.8%。其中男性15例,女性10例。单因素多因素分析都显示肿瘤大小、慢性蝶窦炎与再次手术与脑脊液鼻漏的发生有直接关系,为独立的影响因素(P<0.05)。对25例出现脑脊液鼻漏的患者采用鼻内镜手术进行治疗,全部病例经手术修复后获得一次性治愈。随访6个月,无1例复发,无术后并发症。结论:巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病率比较高,肿瘤大小、慢性蝶窦炎与再次手术为主要的独立危险因素,要积极采用鼻内镜下治疗。
Objective: To investigate the pathogenesis of cerebrospinal fluid rhinorrhea in the transsphenoidal surgery of huge pituitary adenomas and to propose the corrective measures. Methods: 180 patients with giant pituitary adenoma who were diagnosed and treated in our hospital from February 2009 to August 2012 were selected. All patients underwent transsphenoidal surgery for giant pituitary adenoma. Observe the prognosis. Results: Of the 180 patients who underwent transsphenoidal surgery, cerebrospinal fluid rhinorrhea occurred in 25 patients at a rate of 13.8%. Including 15 males and 10 females. Univariate multivariate analysis showed that the size of the tumor, chronic sphenoid sinusitis and reoperation were directly related to the occurrence of cerebrospinal fluid rhinorrhea and were independent factors (P <0.05). Twenty-five patients with cerebrospinal fluid rhinorrhea were treated with endoscopic sinus surgery, and all the cases were cured by surgery. Follow-up 6 months, no recurrence in 1 case, no postoperative complications. CONCLUSION: The incidence of cerebrospinal fluid rhinorrhea in transsphenoidal surgery of giant pituitary adenomas is relatively high. Tumor size, chronic sphenoid sinusitis and reoperation are the main independent risk factors. Endoscopic treatment should be actively adopted.