经蝶窦鞍内手术的颅内血管损伤性并发症

目的 通过回顾性总结分析经蝶窦鞍内手术中发生的8例血管损伤性并发症病例的临床资料,从而提高对这种少见并发症的认识.方法 1964年～2000年间经蝶窦鞍内手术中发生颅内血管损伤性并发症共8例,包括6例蛛网膜下腔出血、1例前海绵间窦出血、1例颈内动脉血栓形成;分析了病人的临床表现、诊断、出血原因,探讨了预防和治疗方法.结果 出血原因为肿瘤残体出血2例,损伤鞍膈或蛛网膜出血4例,前海绵间窦过渡发育1例;手术操作刺激引起颈内动脉血栓形成1例;死亡2例,治愈5例,1例术后肢体偏瘫.结论 经蝶窦鞍内手术并发颅内血管损伤是-种少见的手术并发症,其发生原因复杂,熟悉鞍区解剖结构和熟练操作技术可明显减少该并发症,一旦发生出血应给予综合性治疗.

Complications of transsphenoidal surgery for lesions of sellar region: the intracranial vessel injuries

Objective To improve knowledge of intracranial vessel injury which is a rare complication of trans-sphenoidal surgery (TSS) for lesions of cerebral region. Methods 8 patients who underwent TSS for lesions of cerebral region occurred intracranial vessel injury during 1964~2001. 6 patients of them occurred subarachnoid hemorrhage, 1 patient occurred anterior intercavernous sinus hemorrhage and 1 thrombus of internal carotid artery. The clinical data of all patients were analyzed and methods of prevention and treatment were discussed. Results The rate of intracranial vessel injuries was 4 percent. The reason for SAH hemorrhage was residues of tumor in 2 patients and damaged cerebra and arachnoid in 4 patients. The hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. 2 patients died and 5 patients were cured and 1 patient lived with hemiplegia. Conclusions The injury of intracranial vessels is a rare complication of TSS. The more familiar with anatomy of cerebra and more skillful with TSS, the less the complication occurred.