中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
Chinese Journal of Minimally Invasive Surgery
2015年
10期
922-925
,共4页
姜之全%韩易%徐德才%娄飞云%张少军%郑夏林
薑之全%韓易%徐德纔%婁飛雲%張少軍%鄭夏林
강지전%한역%서덕재%루비운%장소군%정하림
神经内镜%经蝶入路%垂体腺瘤%脑脊液漏
神經內鏡%經蝶入路%垂體腺瘤%腦脊液漏
신경내경%경접입로%수체선류%뇌척액루
Neuroendoscopy%Transsphenoidal approach%Pituitary adenomas%Cerebrospinal fluid leak
目的:探讨神经内镜下修补经蝶入路切除垂体腺瘤术中、术后脑脊液漏的疗效。方法2012年1月~2013年12月神经内镜下修补经蝶入路切除垂体腺瘤术中、术后脑脊液漏19例(20例次)。神经内镜下鞍底修补术均采用“三明治方法”,即采用脂肪、人工硬膜、阔筋膜及肌肉修补缺损。结果单纯神经内镜术中脑脊液漏行神经内镜修补9例,术后再次出现脑脊液漏1例,神经内镜二次修补后未再出现脑脊液漏。显微镜术中发生脑脊液漏10例:术中行神经内镜修补1例;8例显微镜下修补术后再出现脑脊液漏,行神经内镜二次修补;1例由于漏液较少,术中未予修补,仅予腰大池持续引流,术后仍持续脑脊液漏,并在引流第5天出现颅内感染,及时进行神经内镜修补联合持续腰大池外引流后控制感染,未再发生脑脊液漏。神经内镜下一次修补成功率为94.7%(18/19)。19例术后随访1~24个月,平均7个月,无一例复发。结论神经内镜修补经蝶入路术中、术后脑脊液漏安全有效。
目的:探討神經內鏡下脩補經蝶入路切除垂體腺瘤術中、術後腦脊液漏的療效。方法2012年1月~2013年12月神經內鏡下脩補經蝶入路切除垂體腺瘤術中、術後腦脊液漏19例(20例次)。神經內鏡下鞍底脩補術均採用“三明治方法”,即採用脂肪、人工硬膜、闊觔膜及肌肉脩補缺損。結果單純神經內鏡術中腦脊液漏行神經內鏡脩補9例,術後再次齣現腦脊液漏1例,神經內鏡二次脩補後未再齣現腦脊液漏。顯微鏡術中髮生腦脊液漏10例:術中行神經內鏡脩補1例;8例顯微鏡下脩補術後再齣現腦脊液漏,行神經內鏡二次脩補;1例由于漏液較少,術中未予脩補,僅予腰大池持續引流,術後仍持續腦脊液漏,併在引流第5天齣現顱內感染,及時進行神經內鏡脩補聯閤持續腰大池外引流後控製感染,未再髮生腦脊液漏。神經內鏡下一次脩補成功率為94.7%(18/19)。19例術後隨訪1~24箇月,平均7箇月,無一例複髮。結論神經內鏡脩補經蝶入路術中、術後腦脊液漏安全有效。
목적:탐토신경내경하수보경접입로절제수체선류술중、술후뇌척액루적료효。방법2012년1월~2013년12월신경내경하수보경접입로절제수체선류술중、술후뇌척액루19례(20례차)。신경내경하안저수보술균채용“삼명치방법”,즉채용지방、인공경막、활근막급기육수보결손。결과단순신경내경술중뇌척액루행신경내경수보9례,술후재차출현뇌척액루1례,신경내경이차수보후미재출현뇌척액루。현미경술중발생뇌척액루10례:술중행신경내경수보1례;8례현미경하수보술후재출현뇌척액루,행신경내경이차수보;1례유우루액교소,술중미여수보,부여요대지지속인류,술후잉지속뇌척액루,병재인류제5천출현로내감염,급시진행신경내경수보연합지속요대지외인류후공제감염,미재발생뇌척액루。신경내경하일차수보성공솔위94.7%(18/19)。19례술후수방1~24개월,평균7개월,무일례복발。결론신경내경수보경접입로술중、술후뇌척액루안전유효。
Objective To explore the effectiveness of the neuroendoscopic repair of intraoperative and postoperative cerebrospinal fluid (CSF)leaks following transsphenoidal surgery for pituitary adenomas. Methods We retrospectively reviewed a series of 19 patients who underwent endoscopic transnasal CSF leak repair (20 times)following transsphenoidal surgery for pituitary adenomas in our hospital between January 2012 and December 2013. The leak was repaired by “Sandwich Method ” with neuroendoscopy.The fat,artificial dura,fascia lata and muscle grafts were selected for defect closure. Results Neuroendoscopic repair was performed in 9 patients with leak occurred in intraoperation of endoscopic transsphenoidal surgery,one of which had a recurrence of leak and underwent a secondary repair.CSF leak occurred in 10 patients receiving microscopic surgery.Neuroendoscopic repair was given intraoperatively in 1 patient,and secondary neuroendoscopic repair was performed in 8 patients postoperatively.The remaining one patient was given only a lumbar cistern continuous drainage without repair because the leak was not severe,however,the leak was not ceased and intracranial infection occurred 5 days after surgery,then the leak was repaired by neuroendoscopic techniques combined with lumbar drainage.After surgery,the intracranial infection was controlled and the leak disappeared.The success rate was 94.7% (18 /19)after the first closure attempt.All the cases were followed up for 1 -24 months (mean,7 months)after operation and no patients had a relapse. Conclusions The neuroendoscopic transnasal technique for the repair of intraoperative and postoperative CSF leaks is safe and effective.