垂体腺瘤经蝶手术中脑脊液漏的处理

目的 分析垂体腺瘤经蝶手术中脑脊液漏的原因和发生率,探讨术中修补蝶鞍治疗脑脊液漏的方法.方法 回顾性分析1998年1月至2008年5月手术治疗的118例垂体腺瘤患者的临床资料,经蝶手术134例次.术中蝶鞍修补采用两种方法:第一种以自体脂肪组织填充蝶鞍和蝶窦,以自体骨片修补鞍底骨质缺损;第二种以氧化纤维素片、人纤维蛋白明胶海绵和生物胶修补鞍膈及鞍底硬膜缺损,并以自体脂肪组织填充蝶鞍.计算各种垂体腺瘤的比例及其术中、术后脑脊液漏的发生率,所得数据进行统计学分析.结果 生长激素腺瘤患者术中脑脊液漏发生率(26.5%,9/34)明显高于其他类型垂体腺瘤(13.0%,13/100)(P＜0.05).侵袭性垂体腺瘤患者术中脑脊液漏发生率(21.1%,8/38)高于非侵袭性垂体腺瘤(14.6%,14/96)(P＜0.05).术中见鞍膈下降、肿瘤全切除患者术中脑脊液漏发生率(18.7%,20/107)高于部分切除患者(7.4%,2/27)(P＜0.05).采用第二种方法修补蝶鞍的患者手术10例次,其术后无脑脊液漏发生,术后出现并发症1例次(10.0%);而采用第一种方法修补蝶鞍的患者手术12例次,其术后发生脑脊液漏3例次(25.0%),术后出现并发症4例次(33.3%).结论 垂体腺瘤经蝶手术中发生脑脊液漏时以氧化纤维素片、人纤维蛋白明胶海绵和生物胶修补鞍膈和鞍底硬膜缺损的方法可靠,术后无脑脊液漏发生.

The management of cerebrospinal fluid leakage after transsphenoidal surgical removal of pituitary adenomas

Objective To evaluate the incidence and the causes of the intra-and postoperative cerebrospinal fluid(CSF)leakage during transsphenoidal surgical removal of pituitary adenomas,and discuss the sella closure methods.Method During the period from January 1998 to May 2008,118 patients underwent 134 transsphenoidal operations for pituitary adenomas.Two different methods to close the sella were used.The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone.In the second method,tht regenerated oxidized cellulose and collagen sponge with human fibrin were used to cover the seUa membrane defect and the dural defect,followed by packing the seHa with autologous fat.Proportions of each type of pituitary adenomas were analyzed.The frequency of the intra-and postoperative CSF leakage were evaluated in different type tumors and different operations.Data had been studied by statistical analysis.Results The incidence rate of intraoperative CSF leakage(26.5%,9/34)Was obviously increased in patients with growth homone adenoma compared with other type of adenoma(13.0%,13/100).Patients with invasive adenoma had an increased incidence rate of intraoperative CSF leakage(21.1%,8/38)compared with noninvasive adenoma(14.6%,14/96)(P＜0.05).When the descent of the sella turcica membrane Was visualized with tumor being totally removed,the incidence rate of intraoperative CSF leakage increased(18.7%,20/107)compared with when membrane descent was not seen with tumor remaining(7.4%,2/27)(P＜0.05).There were 3 cases postoperative CSF leakage happened in all 12 cases which adopted the first method. By the second method,there was no postoperative CSF leakage,and the number of postoperative complications was significantly smaller than the first method (10.0% and 33.3%,respectively). Conclusions The technique of covering the sella membrane and dural defects with oxidized cellulose and collagen sponge with human fibrin in the presence of intraoperative CSF leakage appears to be the most reliable,as no postoperative CSF leakage after applying this technique has been observed.