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目的评估经鼻蝶入路切除垂体腺瘤术中与术后脑脊液漏的发生原因及频率,讨论鞍底修补的方法。方法 1995至2005年534例垂体腺瘤患者经历了562次经鼻蝶入路手术,其中小腺瘤120例(22.5%),414例为大腺瘤(77.5%)。应用两种方式修补鞍底,其中382例应用体脂肪填塞后用自体骨修复鞍底缺损,152例应用三明治法:生物硬脑膜、明胶海绵、纤维速及纱应用生物蛋白胶粘合修补鞍底。结果 534例患者中486例垂体腺瘤成功完全切除,其中分别为大腺瘤45.3%,小腺瘤91.3%。60例患者发生术后并发症,2例术后死亡,86例患者发生术中脑脊液漏,经自体脂肪填塞鞍底患者3例发生术后脑脊液漏,2例发生蝶窦炎;经“三明治”法修补的患者未发现术后脑脊液漏。结论 “三明治”法治疗术中脑脊液漏患者未发现术后脑脊液漏,是一种安全有效的方式。
Objective To evaluate the causes and frequency of cerebrospinal fluid leakage during and after resection of pituitary adenomas by transnasal approach, and to discuss the method of sella repair. Methods 534 patients with pituitary adenoma from 1995 to 2005 underwent 562 transsphenoidal approaches, of which 120 (22.5%) had small adenomas and 414 (77.5%) had adenomas. Application of two ways to repair the saddle, of which 382 cases of body fat filling with autologous bone repair of sella defect, 152 cases of application of sandwiches: biological dura mater, gelatin sponge, fiber speed and yarn application of biological protein glue adhesive repair saddle . Results Of the 534 patients, 486 cases of pituitary adenomas were successfully resected, of which 45.3% were large adenomas and 91.3% were small adenomas. Sixty patients had postoperative complications, two died after operation, 86 patients had intraoperative cerebrospinal fluid leakage, 3 patients had sequelae of cerebrospinal fluid leakage after operation, and 2 patients had sphenoid sinusitis. “Method repair patients found no postoperative cerebrospinal fluid leakage. Conclusion There is no postoperative cerebrospinal fluid leakage in patients with cerebrospinal fluid leakage in ”Sandwich" therapy, which is a safe and effective way.