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经鼻内镜经蝶窦手术中使用人工硬脑膜进行鞍区重建的并发症发生率低。

Low complication rate of sellar reconstruction by artificial dura mater during endoscopic endonasal transsphenoidal surgery.

作者信息

Ye Yuanliang, Wang Fuyu, Zhou Tao, Luo Yi

机构信息

Department of Neurosurgery, The 3rd Affiliated Hospital of Guangxi Traditional Chinese Medical University, Liuzhou, Guangxi Autonomous Region Department of Neurosurgery, PLA 301 Hospital, Beijing, China.

出版信息

Medicine (Baltimore). 2017 Dec;96(52):e9422. doi: 10.1097/MD.0000000000009422.

Abstract

To evaluate effect of sellar reconstruction during pituitary adenoma resection surgery by the endoscopic endonasal transsphenoidal approach using artificial cerebral dura mater patch.This was a retrospective study of 1281 patients who underwent endoscopic transsphenoidal resection for the treatment of pituitary adenomas between December 2006 and May 2014 at the Neurosurgery Department of the People's Liberation Army General Hospital. The patients were classified into 4 grades according to intraoperative cerebrospinal fluid (CSF) leakage site. All patients were followed up for 3 months by telephone and outpatient visits.One thousand seventy three (83.7%) patients underwent sellar reconstruction using artificial dura matter patched outside the sellar region (method A), 106 (8.3%) using artificial dura matter patched inside the sellar region (method B), and 102 (8.0%) using artificial dura matter and a mucosal flap (method C). Method A was used for grade 0-1 leakage, method B for grade 1 to 2 leakage, and method C for grade 2 to 3 leakage. During the 3-month follow-up, postoperative CSF leakage was observed in 7 patients (0.6%): 2 among patients who underwent method B (1.9%) and 5 among those who underwent method C (4.9%). Meningitis was diagnosed in 13 patients (1.0%): 2 among patients who underwent method A (0.2%), 4 among those who underwent method B (3.8%), and 7 among those who underwent method C (6.7%).Compared with other reconstruction methods, sellar reconstruction surgery that only use artificial dura mater as repair material had a low rate of complications.

摘要

通过鼻内镜经蝶窦入路使用人工硬脑膜补片评估垂体腺瘤切除术中鞍区重建的效果。这是一项对2006年12月至2014年5月在解放军总医院神经外科接受内镜经蝶窦切除术治疗垂体腺瘤的1281例患者的回顾性研究。根据术中脑脊液漏出部位将患者分为4级。所有患者通过电话和门诊随访3个月。1073例(83.7%)患者在鞍区外使用人工硬脑膜补片进行鞍区重建(方法A),106例(8.3%)在鞍区内使用人工硬脑膜补片(方法B),102例(8.0%)使用人工硬脑膜和黏膜瓣(方法C)。方法A用于0 - 1级漏,方法B用于1 - 2级漏,方法C用于2 - 3级漏。在3个月的随访期间,7例患者(0.6%)出现术后脑脊液漏:方法B组2例(1.9%),方法C组5例(4.9%)。13例患者(1.0%)被诊断为脑膜炎:方法A组2例(0.2%),方法B组4例(3.8%),方法C组7例(6.7%)。与其他重建方法相比,仅使用人工硬脑膜作为修复材料的鞍区重建手术并发症发生率较低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c67/6392657/8f76dad8fe97/medi-96-e9422-g001.jpg

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