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[经扩大鼻内镜经鼻蝶入路诊治颅咽管瘤术后并发症的经验]

[Experience in the diagnosis and treatment of the postoperative complications of craniopharyngiomas through expanded endoscopic endonasal transsphenoidal approach].

作者信息

Lu Xing, Hang Wei, Liu Hui, Xue Kai, Zhang Xiaochen, Liu Gang

机构信息

Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Huanhu Hospital,Tianjin,300350,China.

Department of Radiology,Tianjin Huanhu Hospital.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jun;35(6):505-510. doi: 10.13201/j.issn.2096-7993.2021.06.005.

Abstract

To summarize the clinical characteristics of the postoperative complications of surgical resection of craniopharyngiomas through expanded endoscopic endonasal transsphenoidal approach (EEETA). Strategies for prevention and management were also discussed. The clinical data of the patients who were treated through EEETA were retrospectively reviewed. The occurrence of post-operative complications were recorded. Partial removal of the tumors were accomplished in 11 cases and subtotal removal in 4 cases. The major postoperative complications were anterior pituitary hypofunction(11/15), diabetes insipidus(8/15), epistaxis(3/15), cerebrospinal fluid rhinorrhea(1/15). The cases were treated symptomatically or by re-operation. Of all the cases,10 patients were improved,1 patient had drowsiness,3 suffered from multiple organ failure,and 1 patient died. To prevent and reduce the postoperative complications of EEETA, first of all, it is essential to evaluate the need for surgical intervention and perform a comprehensive preoperative assessment. Critical nerves and vessels should be preserved carefully during operation for the sake of avoiding injuries normal pituitary and hypothalamus. Furthermore, reconstruction of the skull base is critical. The standard procedure of nasal endoscopy and the experience of the surgeons are quite significant, while the operation needs multidisciplinary collaborations.

摘要

总结经扩大鼻内镜经蝶窦入路(EEETA)手术切除颅咽管瘤术后并发症的临床特点。同时探讨其预防和处理策略。回顾性分析经EEETA治疗患者的临床资料,记录术后并发症发生情况。11例患者肿瘤部分切除,4例次全切除。术后主要并发症为垂体前叶功能减退(11/15)、尿崩症(8/15)、鼻出血(3/15)、脑脊液鼻漏(1/15)。针对这些病例进行了对症治疗或再次手术。所有病例中,10例患者病情好转,1例嗜睡,3例发生多器官功能衰竭,1例死亡。为预防和减少EEETA术后并发症,首先,必须评估手术干预的必要性并进行全面的术前评估。术中应仔细保护重要神经和血管,避免损伤正常垂体和下丘脑。此外,颅底重建至关重要。鼻内镜的标准操作和术者的经验非常重要,同时手术需要多学科协作。

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