摘要：

目的 对垂体生长激素腺瘤患者神经内镜下经鼻蝶入路手术后感染特点及危险因素进行探讨，并总结诊断与治疗经验。方法 采集2016年1月至2019年10月行神经内镜下经鼻蝶入路手术的122例垂体生长激素腺瘤患者的临床资料，统计术后感染发生率、分析术后感染与体温之间的关系，以及诱发术后感染的危险因素。结果 生长激素腺瘤患者术后感染率高于同期接受手术治疗的其他类型垂体腺瘤患者［9.84%（12/122）对3.77%（8/212），P=0.025］，感染类型以中枢神经系统感染（7例）和菌血症（4例）为主，致病菌主要为革兰阴性杆菌（10例）；感染组（12例）术后峰值体温高于非感染组（110例，P=0.000），且峰值体温出现时间更晚（P=0.000）；多因素Logistic回归分析显示，术中脑脊液鼻漏（OR=5.520，95% CI：1.193~25.551；P=0.029）和女性（OR=7.804，95% CI：1.088~55.948；P=0.041）为发生术后感染的主要危险因素。结论 在行神经内镜手术的垂体腺瘤患者中，以垂体生长激素腺瘤患者术后感染率较高，且该部分患者术后感染是由于女性、术中发生脑脊液鼻漏以及发热出现时间较晚等；早期识别并及时治疗至关重要，经验性抗生素治疗应覆盖革兰阴性杆菌；对于术中发生严重脑脊液鼻漏的患者，自体脂肪筋膜加鼻中隔黏膜瓣修补具有一定预防作用。

关键词: 分泌生长激素的脑垂体腺瘤, 蝶窦, 神经内窥镜, 手术后并发症, 感染

Abstract:

Objective To explore the characteristics, risk factors of postoperative infections for patients with growth hormone (GH)-secreting pituitary adenoma after endoscopic transsphenoidal surgery, and to share the experience of diagnosis and treatment of these patients. Methods A total of 122 patients with GH-secreting pituitary adenoma who underwent endoscopic transsphenoidal surgery were included from January 2016 to October 2019, and the data of postoperative body temperature, postoperative infection and related possible risk factors were analyzed. Results The incidence of postoperative infections in patients with acromegaly was significantly higher than that with other types of pituitary adenomas[9.84% (12/122) vs. 3.77% (8/212), P=0.025]. Central nervous system infection (7 cases) and bacteremia (4 cases) were the most common types of infections. Gram-negative bacilli were predominant (10 cases). The postoperative peak body temperature of patients with infections (12 cases) was significantly higher (P=0.000) and appeared later than non-infectious group (110 cases, P=0.000). Multivariate Logistic analysis showed that intraoperative cerebrospinal fluid leakage (OR=5.520, 95% CI:1.193-25.551; P=0.029) and female (OR=7.804, 95% CI:1.088-55.948; P=0.041) patients were major risk factors for postoperative infections. Conclusions For patients with GH-secreting pituitary adenoma who underwent endoscopic surgery, postoperative infections were uncommon but serious complication, especially for females, for those who experienced intraoperative cerebrospinal fluid leakage and postoperative peak body temperature delayed. Early identification and timely treatment are very important. Empirical anti-infective treatment should cover Gram-negative bacteria. Repair using autologous fat fascia and nasoseptal flap may reduce the incidence of postoperative infections in patients who suffered severe cerebrospinal fluid leakage.

Key words: Growth hormone-secreting pituitary adenoma, Sphenoid sinus, Neuroendoscopes, Postoperative complications, Infection