单鼻孔经蝶窦入路垂体瘤切除术后脑脊液鼻漏的治疗探讨刘素华.docVIP

精品论文 参考文献 单鼻孔经蝶窦入路垂体瘤切除术后脑脊液鼻漏的治疗探讨刘素华 山东潍坊滨海经济开发区人民医院 262700 摘要：目的 分析单鼻孔经蝶窦入路垂体瘤切除术后发生脑脊液鼻漏的原因，总结治疗经验。方法 总结7例单鼻孔经蝶窦入路垂体瘤切除术后发生脑脊液鼻漏病人的治疗经验。结果 1例术后2年垂体瘤复发并发生脑脊液鼻漏，6例为巨大垂体腺瘤术后1周内发生鼻漏，1例经蝶修补治愈，6例去枕平卧或腰大池引流保守治疗治愈。结论　垂体瘤术后发生鼻漏多见于巨大侵袭型腺瘤，术中操作失误及鞍底蝶窦壁填塞不严密，是发生鼻漏的重要原因。术后腰大池引流，去枕平卧有助于漏口愈合，经蝶入路修补是最佳手术入路和方法。 关键词：垂体；腺瘤；脑脊液鼻漏 【Summary 】the purpose is analytical list nostril through Die Dou go into the road take place after hanging the body lump the resection the reason that the brain ridge liquid nose leaks，the summary cures experience.The brain ridge liquid nose happens to method after tallying up 7 single nostrils go into road to hang body lump through the Die Dou the resection to leak the patients treatment experience.Hang body lump to relapse to erupt to living the brain ridge liquid nose to leak for 2 years after result a Shu，6 for huge hang the body gland lump Shu behind 1 with in the week take place the nose leak，a Be cured of by Die repair，6 go to Zhen even lie or waist the big pond lead to flow a conservative treatment to cure of.Noses happening to conclusion after hanging the body lump the Shu to leak is seen to more huge hit type gland lump，operate mistake and the saddle bottom Die Dou in the Shu the wall stop up not tight，is important reason that take place noses leak.The Shu small of the back big pond leads to flow and go to Zhen even the repair lying to contribute to leaking to heal，going into road through the Die is the best surgical operation into road and method. 【Keyword 】hang the body gland lump brain ridge liquid nose to leak 单鼻孔经蝶窦入路垂体瘤切除术后发生脑脊液鼻漏临床并不少见，约1.5%-4%[1]，治疗难度较大，收集2005年6月至2007年12月期间入院7例单鼻孔经蝶窦入路垂体瘤切除术后发生脑脊液鼻漏患者，1例经蝶手术治疗，6例去枕平卧或腰大池引流保守治疗，随访8个月至12个月，效果满意，现报告如下。 1.资料与方法 1.1 临床资料 7例患者，女性4例，男性3例，年龄：24岁-70岁，1例术后2年垂体瘤复发并发生脑脊液鼻漏，6例为巨大垂体腺瘤术后1周内发生鼻漏，按垂体瘤质地分类：6例质地软，1例质地中等，按内分泌学结合临床症状分类：无功能腺瘤3例，其中1例以头痛为唯一症状就诊，功能性腺瘤4例。均为PRL腺瘤，血清PRL测定均gt;2120mu;Iu/ml，其中闭经-泌乳2例，单纯闭经或月经紊乱2例，视力视野障碍4例。影像学检查：7例术前均行MRI、CT及蝶鞍冠扫CT，均见蝶鞍明显扩大，鞍底变薄或消失