神经内镜下经鼻蝶垂体瘤手术脑脊液漏修补失败原因及治疗的探讨

摘要

Objective To investigate reasons and treatment of cerebrospinal fluid leakage after reconstruction of basilar pituitary fossa in pituitary adenoma surgery by neural endoscopy.Methods The clinical data of 226 patients with pituitary adenoma underwent neural endoscopic surgery in department of neurosurgery of Nantong University Affiliated Hospital, were analyzed retrospectively.34 cases of cerebrospinal fluid leakage were reconstructed basilar pituitary fossa in pituitary adenoma surgery, 6 cases of postoperative cerebrospinal fluid leak were undergwent surgical treatment again and reconstructed basilar pituitary fossa by fat, femoral fascia, surgicel, biological fibrn glue and artificial duramater. Nasopore was used to packing the bottom of the saddle.Some cases were routine postoperative lumbar drainage for 7 to 10 days.Results All cases were repaired successfully, the follow-up from 3 to 30 months showed no cerebrospinal fluid leakage occurred.Conclusions Intraoperative and postoperative effective treatment measures are related to prognosis."Multilayer sandwich repair" method is effective and reliable treatment measures in repairing cerebrospinal fluid leakage during surgery of pituitary adenoma by neural endoscopy.Routine postoperative lumbar drainage is useful and valid.%目的 探讨神经内镜下经鼻蝶垂体瘤手术脑脊液漏修补失败的原因及治疗.方法 回顾性分析南通大学附属医院神经外科收治226例垂体瘤患者内镜下行手术治疗,34例术中发生脑脊液漏行修补术,6例术后发生脑脊液漏,再次手术治疗,术中追寻脑脊液流出路径查找漏口,取脂肪及阔筋膜,结合速即纱、生物蛋白胶修补漏口,人工硬脑膜敷贴,纳吸棉支撑鞍底.术后常规腰大池持续引流7~10 d.结果 4例术中发生脑脊液漏行修补术,6例术后发生脑脊液漏,再次行脑脊液漏修补术,均康复出院.术后随访3~30个月,未见脑脊液漏发生.结论 神经内镜下仔细辨别查找脑脊液漏的部位,术中、术后正确有效的处理措施关系脑脊液漏修补成败.脂肪、阔筋膜、速即纱结合生物蛋白胶、人工硬脑膜多层的"三明治"修补方法有效可靠.