| 王飞,贺虎,王安硕,等.改良补救黏膜瓣在神经内镜经鼻蝶入路切除垂体腺瘤手术中的效果及安全性[J].中国临床保健杂志,2022,25(5):667-671. |
| 改良补救黏膜瓣在神经内镜经鼻蝶入路切除垂体腺瘤手术中的效果及安全性 |
| Effect and safety of modified nasoseptal rescue flap in endoscopic transsphenoidal surgery for pituitary adenomas |
| 投稿时间：2022-08-17 |
| DOI：10.3969/J.issn.1672-6790.2022.05.020 |
| 中文关键词: 垂体腺瘤 垂体切除术 鼻中隔 嗅觉丧失 |
| 英文关键词: Pituitary neoplasms Hypophysectomy Nasal septum Anosmia 〖FL |
| 基金项目:国家自然科学基金项目(52073269)；安徽省博士后基金项目(2019B322) |
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| 中文摘要: |
| 目的 探讨改良补救鼻中隔黏膜瓣在神经内镜经鼻蝶入路切除垂体腺瘤手术中的效果及安全性。方法 回顾性分析2021年1—6月期间在中国科学技术大学附属第一医院(安徽省立医院)神经外科接受神经内镜经鼻蝶入路手术切除的28例垂体腺瘤患者,按照随机数字表法分成研究组(改良补救鼻中隔黏膜瓣组)和对照组(经典鼻中隔转移黏膜瓣组)。研究组15例,手术初期制作改良补救鼻中隔黏膜瓣,如术毕未发生脑脊液漏,则将黏膜瓣复位,如发生脑脊液漏,则制作鼻中隔鼻底黏膜瓣,进行鞍底重建；对照组13例,手术初期制作经典鼻中隔转移黏膜瓣,术毕无论是否发生脑脊液漏,均进行黏膜瓣鞍底重建。比较2组之间在磨除鞍底前耗时、术中脑脊液漏修补成功率、术后嗅觉功能、肿瘤全切除率等指标之间的差异。结果 磨除鞍底前耗时:研究组16～35(23.47±6.06)min；对照组25～45(37.62±4.84)min,2组比较,P＜0.05。术中脑脊液漏修补成功率:研究组术中发生脑脊液漏率26.67%,对照组术中发生脑脊液漏率23.08%,2组比较,P＞0.05,均成功修补。术后嗅觉功能:研究组15例患者术后嗅觉均正常；对照组13例患者中,6例术后嗅觉功能障碍(P＜0.05)。肿瘤全切除率:研究组肿瘤全切除率为86.67%,对照组肿瘤全切除率为92.31%,2组比较,P＞0.05。围术期无重大并发症,随访期无死亡病例。结论 在神经内镜经鼻蝶入路切除垂体腺瘤手术中,应用改良补救鼻中隔黏膜瓣技术,可明显缩短手术时间、有效保护患者嗅觉功能、改善鼻腔舒适度,且不影响术中脑脊液漏修补成功率和肿瘤全切除率。 |
| 英文摘要: |
| Objective To investigate effect of modified nasoseptal rescue flap in endoscopic transsphenoidal surgery for pituitary adenomas.Methods A retrospective analysis was made of 28 patients with pituitary adenomas who underwent endoscopic transsphenoidal surgery in the department of neurosurgery of the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from January 2021 to June 2021.They were randomly divided into experimental group and control group.In the experimental group,15 cases were treated with modified rescue nasoseptal flap at the beginning of the operation.If cerebrospinal fluid leakage did not occur after the operation,the flap was reset.If cerebrospinal fluid leakage occurred,the nasoseptal and nasal floor flap was made for saddle bottom reconstruction.In the control group,13 cases were treated with classic nasoseptal flap at the beginning of the operation.After the operation,whether there was cerebrospinal fluid leakage or not,the sellar floor of the nasoseptal flap was reconstructed.The differences between the two groups in the time before grinding the sellar floor,the success rate of cerebrospinal fluid leakage repair during operation,the postoperative olfactory function,the total tumor resection rate and other indicators were compared.Results Time before grinding the saddle bottom:in the experimental group,16-35 min,with an average of (23.47±6.06) min;The control group,25-45 min,with an average of (37.62±4.84) min (P<0.05).The success rate of cerebrospinal fluid leakage repair during operation:4/15 cases of cerebrospinal fluid leakage occurred during operation in the experimental group was and 3/13 in the control group (P>0.05).All repaired successfully.Postoperative olfactory function:15 patients in the experimental group had normal olfactory function after operation;among the 13 patients in the control group,6 had postoperative olfactory dysfunction (P<0.05).Total tumor resection rate:the experimental group was 86.67% and the control group was 92.31%(P>0.05).There were no deaths during the follow-up period.There were no major complications during the perioperative period.Conclusions In endoscopic transsphenoidal surgery for pituitary adenomas,the application of modified nasoseptal rescue flap can significantly shorten the operation time,effectively protect the olfactory function of patients,improve nasal comfort,without affecting the success rate of cerebrospinal fluid leakage repair and total tumor resection rate. |
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