大型及巨大型垂体腺瘤经蝶手术术后脑脊液鼻漏的危险性因素分析

目的探讨大型及巨大型垂体腺瘤经蝶手术后发生脑脊液鼻漏的相关危险性因素。方法回顾性分析592例大型及巨大型垂体腺瘤病人的临床资料,均采取经蝶手术。结果术后发生脑脊液鼻漏26例。肿瘤大小、再次手术、肿瘤的质地和边缘与术后脑脊液鼻漏的发生相关;肿瘤的侵袭性、术前口服溴隐亭和肿瘤的切除程度与术后脑脊液鼻漏无关。脑脊液鼻漏的首次修补成功率为92.9%。26例脑脊液鼻漏病人中,5例发生脑膜炎;4例出现脑积水,行脑室-腹腔分流术缓解。结论巨大垂体腺瘤、再次手术、腺瘤的表面不光滑和质地韧者可能使发生术后脑脊液鼻漏的风险增加。经蝶手术入路是修补此类脑脊液鼻漏的最佳途径。

Risk factors for cerebrospinal fluid rhinorrhea following transsphenoidal surgery for large and giant pituitary adenomas

Objective To explore the risk factors for postoperative cerebrospinal fluid rhinorrhea following transsphenoidal surgery for large and giant pituitary adenomas.Methods Clinical data of 592 cases were analyzed retrospectively.All the patients received transsphenoidal pituitary adenoma surgery.Results Postoperative cerebrospinal fluid rhinorrhea occurred in 26 cases.The size, texture and margin of tumors and reoperation were independently associated with postoperative cerebrospinal fluid rhinorrhea.The tumor invasiveness, bromocriptine treatment and extent of excision were not associated with occurrence of postoperative cerebrospinal fluid rhinorrhea.The success rate of cerebrospinal fluid rhinorrhea repairs was 92.9%.Of the 26 patients with postoperative cerebrospinal fluid rhinorrhea, 5 were complicated with meningitis and 4 with hydrocephalus and required ventriculoperitoneal shunt.Conclusion The size, reoperation, texture and margin of tumor were risk factors for postoperative cerebrospinal fluid rhinorrhea.Endoscopic and microscopic repairs were the effective techniques for postoperative cerebrospinal fluid rhinorrhea.