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目的探讨内窥镜经单鼻孔蝶窦入路切除垂体瘤术中脑脊液漏的处理及颅底重建要点。方法术中辨明脑脊液漏的原因,观察蛛网膜破口确切位置,或脑脊液流出方向,针对性进行脑脊液漏的修补。过程分为1修补鞍隔小漏口用明胶海绵塑型填塞;大的漏口用自身脂肪塑型填塞。骨性裂隙用骨蜡密封。长针头均匀注入纤维蛋白胶或EC胶封闭。2重建鞍底略大于鞍底术野窗的人工硬脑膜,置入鞍内,再予薄层速即纱,使之与鞍内硬膜接触均匀,长针头均匀注入纤维蛋白胶或EC胶。再用有一定支持强度可吸收人工硬脑膜,根据鞍底骨窗大小和形状修剪,略大于鞍底,置于鞍外。医用胶充填各层及间隙,使鞍底内外连为一个整体。3加固鞍底对于鞍隔破口很大,进一步于大腿外侧取适度大小肌肉条,捶打成肌浆,平铺于鞍底,用明胶海绵柔性挤压,使之适形地消除鞍底与肌浆之间隙,纤维蛋白胶或EC胶等医用胶固定。结果本组术中发生脑脊液漏12例。其中2例破口位于前方鞍隔,10例位于上方鞍隔。术中均满意修补。术后随访2~12个月,平均7个月,未发生脑脊液鼻漏。结论经单鼻孔蝶窦入路切除垂体瘤并发脑脊液漏,术中及时行个性化的多重夹层式修补,有效可靠。
Objective To investigate the treatment of cerebrospinal fluid leakage and end-cranial reconstruction of endoscopic pituitary tumor by single-nostril sphenoid sinus approach. Methods Identify the causes of cerebrospinal fluid leakage during operation, observe the exact location of arachnoid tears, or the direction of cerebrospinal fluid outflow, and repair the leakage of cerebrospinal fluid. The process is divided into a repair saddle septa with a small gelatin sponge plastic packing; large leak with their own fatty plastic packing. Bone fissures sealed with bone wax. Long needle evenly injected fibrin glue or EC glue closed. 2 Reconstruction of the saddle is slightly larger than the artificial dura at the end of the saddle surgery wild window, placed in the saddle, and then a thin layer of yarn that is, so that the saddle within the dural contact, the long needle uniformly injected fibrin glue or EC glue. Then there is a certain degree of support strength can absorb artificial dura, according to the size and shape of the saddle bone window trimmed slightly larger than the saddle, placed in the saddle. Medical plastic filling layers and gaps, the saddle inside and outside as a whole. 3 Reinforced saddle at the end of saddle for a large break, and further to the right thigh to take the appropriate size muscle strips, thrashing into sarcoplasmic reticulum, tile in the saddle at the end, with gelatin sponge flexible squeeze, so that the condoms and saddle to eliminate Gap interstices, fibrin glue or plastic glue and other medical glue fixed. Results The group occurred in 12 cases of cerebrospinal fluid leakage. Among them, 2 cases were located in the anterior septum and 10 in the upper septum. Surgery are satisfied with the repair. The patients were followed up for 2 to 12 months, with an average of 7 months. Cerebrospinal fluid rhinorrhea did not occur. Conclusion Single nostril sphenoid sinus approach resection of pituitary tumor with cerebrospinal fluid leakage, intraoperative and timely personalized multi-sandwich repair, effective and reliable.