经蝶窦垂体手术:两种鞍区重建技术的比较及其对术后脑脊液漏的影响。
Transsphenoidal pituitary surgery: comparison of two sellar reconstruction techniques and their effect on postoperative cerebrospinal fluid leakage.
作者信息
Schuss Patrick, Hadjiathanasiou Alexis, Klingmüller Dietrich, Güresir Ági, Vatter Hartmut, Güresir Erdem
机构信息
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
Division of Endocrinology and Diabetes, Department of Medicine I, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
出版信息
Neurosurg Rev. 2018 Oct;41(4):1053-1058. doi: 10.1007/s10143-018-0949-x. Epub 2018 Feb 1.
Transsphenoidal surgery is a common procedure in patients with pituitary adenomas. Several techniques have been previously postulated to achieve sufficient sellar reconstruction to avoid cerebrospinal fluid (CSF) leakage. We analyzed our institutional database concerning two sellar reconstruction techniques and development of postoperative CSF leakage. From 2009 to 2015, 255 patients underwent transsphenoidal pituitary surgery at our institution. According to the technique used for sellar reconstruction, patients were divided into two groups: (1) with muscle patch and fibrin glue and (2) with fibrin glue alone. Postoperative CSF leakage occurred in 7% of the patients. Occurrence of postoperative CSF leakage did not differ significantly between both sellar reconstruction techniques (p = 0.2). Patients who underwent sellar reconstruction with fibrin glue alone had significantly shorter operating time (p < 0.0001), as well as shorter length of hospital stay (p = 0.01). On multivariate analysis, occurrence of intraoperative CSF leakage was the only predictor for postoperative CSF leakage (p < 0.0001). The present data suggests that sellar reconstruction after transsphenoidal pituitary surgery seems to be equally effective in preventing postoperative CSF leakage. However, the use of fibrin glue alone results in shorter hospital stay and operating time without exposing patients to more frequent CSF leakage.
经蝶窦手术是垂体腺瘤患者的常见手术。此前已提出多种技术来实现充分的鞍区重建以避免脑脊液(CSF)漏。我们分析了我院关于两种鞍区重建技术及术后脑脊液漏发生情况的数据库。2009年至2015年,我院有255例患者接受了经蝶窦垂体手术。根据用于鞍区重建的技术,患者被分为两组:(1)使用肌肉补片和纤维蛋白胶;(2)仅使用纤维蛋白胶。7%的患者发生了术后脑脊液漏。两种鞍区重建技术术后脑脊液漏的发生率无显著差异(p = 0.2)。仅使用纤维蛋白胶进行鞍区重建的患者手术时间显著更短(p < 0.0001),住院时间也更短(p = 0.01)。多因素分析显示,术中脑脊液漏的发生是术后脑脊液漏的唯一预测因素(p < 0.0001)。目前的数据表明,经蝶窦垂体手术后的鞍区重建在预防术后脑脊液漏方面似乎同样有效。然而,仅使用纤维蛋白胶可缩短住院时间和手术时间,且不会使患者脑脊液漏的发生率更高。