经蝶窦入路垂体腺瘤切除术中脑脊液漏的影响因素和修补方法

目的 分析经蝶窦入路垂体腺瘤切除术中脑脊液漏的影响因素和修补措施.方法 回顾性总结2005年1月至2006年12月650例垂体腺瘤经蝶窦手术过程中出现脑脊液漏的70例病人,分析经蝶窦人路垂体腺瘤切除术中脑脊液漏的影响因素,与肿瘤大小、位置和类型的关系.结果 经蝶窦入路垂体腺瘤切除术出现的脑脊液漏经术中修补后,术后未出现脑脊液鼻漏.结论 垂体腺瘤经蝶窦入路垂体腺瘤切除术中脑脊液漏的发生率为10.8%,垂体ACTH微腺瘤术中脑脊液漏的发生率较高与切除瘤周垂体组织有关.采用自身组织填塞,术后卧床能有效地防止术后脑脊液鼻漏.对于经蝶窦入路垂体腺瘤切除术中严重脑脊液漏者应采用腰蛛网膜下腔置管引流脑脊液.

Influence factors and repair of cerebrospinal fluid rhinorrhea created at the time of transsphenoidal pituitary adenomectomies

Objective To study the influence factors and repair of cerebrospinal fluid(CSF)rhinorrhea created at the time of transsphenoidal pituitary adenomectomies.Method 70 patients with CSF rhinorrhea found during transsphenoidal operation were investigated in this retrospective study.28 patients were males and 42 females.Their age were 21～65 years old,mean age was 35.8 years old.Mean history was 3.1 years.Pituitary adrenocorticotropic hormone(ACTH)-releasing adenomas were diagnosed in 17 patients,pituitary growth hormone(GH)-releasing adenomas were diagnosed in 14 patients,prolactinomas in 6 cases,and non-functional adenomas in 11 cases.Transsphenoidal operation was performed on all patients.CSF leaking was found during transsphenoidal operation.Tissue grafts,fibrin glue,lumbar drain placement or bedrest for 3-10 days were used in repairing CSF leakage.Results There was no postoperative CSF rhinorrhea.Conclusions The incidence of CSF leakage during transsphenoidal operation is 10.8%.It is higher in pituitary ACTH releasing adenomas because the pituitary anterior lobe tissue around adenomas is partly removed.It is safe and effective to repair CSF leakage by using tissue grafts,fibrin glue and bed rest.Lumbar drain placement should be used for serious CSF leak during operation.