神经内镜下经鼻蝶入路垂体瘤切除术中脑脊液鼻漏修补方法的探讨

目的:探讨神经内镜下经鼻蝶入路垂体瘤切除术中脑脊液鼻漏的有效修补方法。方法:回顾性分析2014年6月至2016年6月神经内镜下修补经鼻蝶入路垂体瘤切除术中发生的脑脊液鼻漏的患者20例，术中所采用的修补方法为自体组织“三明治法”结合筛骨垂直板液性骨粉，即自体脂肪、阔筋膜和肌浆结合筛骨垂直板液性骨粉进行修补，人工硬脑膜贴附，碘仿纱条支撑鞍底，术后预防造成颅内压升高的因素。结果:19例患者均一次性修补成功，治愈率为95.0%，无继发性颅内感染发生，1例患者二次修补后治愈。术后随访3～24个月，未见脑脊液鼻漏复发。结论:对于经鼻蝶入路垂体瘤切除术中发生的脑脊液鼻漏，采用“三明治法”结合筛骨垂直板液性骨粉修补的方法具有便捷、确实、高效的优点，合理使用多种不同组织来源的自体修补材料可提高手术的成功率，减少颅内感染的发生率。

The discussion on treating method for neuroendoscopic treatment of the intraoperative cerebrospinal fluid(CSF) leak caused by the transsphenoidal pituitary adenoma resection

Objective:To discuss the effective treating method for trans-endoscopic treatment of the CSF leak caused by the transsphenoidal pituitary tumor resection.Methods:The data of 20 cases of intraoperative CSF leak caused by transsphenoidal pituitary tumor resection from June 2014 to June 2016 were retrospectively analysed,the repairing method adopted during the operation were "sandwich method" combined with liquid bone powder of perpendicular plate of ethmoid bone,that means autologous fat,facia lata and muscle syrup combined with liquid bone powder of perpendicular plate of ethmoid bone,then the artificial dura mater be patched and iodoform gauze were applied for supporting the sellar.After the operation the patients underwent precaution for the intracranial infection.Results:19 patients were successfully be repaired,the cure rate is 95.0% and without the intracranial infection occurred,1 patient was healed through the second operation.After the operation all the patients underwent follow-up for 3～24 months,no CSF leak recurrence occurred.Conclusion:The neuroendoscopic repairing methods for intraoperative CSF leak caused by the pituitary tumor resection equip the advantage such as convenient,practical,high effective,the rational application of multiple different tissue origin autologous materials is conductive to improve the success rate of the operation and reduce the incidence of the intracranial infection.