垂体腺瘤经蝶窦显微手术并发脑脊液漏的防治..docVIP

垂体腺瘤经蝶窦显微手术并发脑脊液漏的防治 ???????? ???? 【关键词】? 脑脊液漏 ???? 　【摘要】 目的? 探讨垂体腺瘤经蝶窦入路手术并发脑脊液漏的防治。 方法? 回顾性分析230例显微镜下经蝶窦垂体瘤切除术中，39例术中发生脑脊液漏。术中用自体脂肪、肌肉浆及耳脑胶修补，4例术后出现脑脊液鼻漏。 结果? 用自体脂肪等修补39例脑脊液漏，其中35例术后未发生脑脊液漏;术后发生脑脊液漏4例，其中2例经腰穿脑脊液持续引流5天自愈，另2例须再次经蝶窦手术予以鞍底修补并治愈。无脑膜炎。 结论? 应用自体脂肪、肌肉浆修补经蝶垂体腺瘤切除术中脑脊液漏是有效的方法，术后并发脑脊液漏应行腰穿脑脊液持续引流，1周内未治愈者应再次经蝶窦手术予以鞍底修补。???? 　　【关键词】? 脑脊液漏;垂体瘤;经蝶手术???????? 　　Prevention and treatment of cerebrospinal fluid leak during or after transsphe-noidal pituitary adenomas surgery????? 　　LIN Fulu，YUE Zhi-jian，ZHOUXiao-ping，et al. 　　Department of Neurosurgery，Second MilitaryMedical Univer-sity Changhai Hospital，Shanghai200433，China ??? 【Abstract】 Objective To explore the techniques for prevention and treatment of cerebrospinal fluid leak during or after transsphenoidal pituitary adenomas surgery.Methods Retrospective study of230patients received transsphe-noidal neurosurgery for resection of the pituitary adenomas.In the39patients with CSF leakage during surgery the sel-lar floors were sealed by free autogenic muscle mash，fat and ebonite，of which4patients occurred CSF leakage after surgery.Results In the39patients with CSF leakage during surgery4patients occurred CSF rhinorrhea after surgery，of which2patients cured with lumber drainage in5days，another2patients required reoperation.No case occurred meningitis.Conclusion Using free autogenic muscle mash，fat and ebonite to repaired the sellar floors in case of CSF leakage during surgery is a effective measurement.Patients with CSF rhinorrhea after surgery require lumber drainage，and should be reoperated without cure in a week. ??? 【Key words】 cerebrospinal fluid leakage;pituitary tumor;transsphenoidal surgery?????? 　　经蝶垂体瘤切除手术中，脑脊液漏是最常见的并发症之一。本文就垂体瘤经蝶术中、术后脑脊液漏的防治进行探讨。???? 　　1 资料与方法???? 　　1.1 一般资料 收集我科2000年7月～2004年10月230例经鼻蝶垂体瘤切除术病例。其中术中出现脑脊液漏39例，男23例，女16例，年龄18～75岁，平均43.5岁。术后出现脑脊液鼻漏4例，均为术中出现脑脊液漏且行自体脂肪修补者。 ??? 1.2 影像学资料 全组病人术前均行冠状位头颅CT和MR检查，肿瘤直径1.5～6.7cm，其中向鞍上生长者186例，向鞍旁生长者44例。 ??? 1.3 手术方法 所有患者均采用显微镜下经鼻蝶窦垂体腺瘤切除术，