鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用

doi:10.3969/j.issn.1672-6731.2021.04.015

中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (4): 324-328. doi: 10.3969/j.issn.1672-6731.2021.04.015

2 鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用

刘志远, 赵亮, 章佳耀, 王宇, 鲁艾林, 赵鹏

210029 南京医科大学第一附属医院神经外科

收稿日期:2021-03-31 出版日期:2021-04-25 发布日期:2021-04-27
通讯作者: 赵鹏,Email:zhaopeng@njmu.edu
基金资助:
国家自然科学基金资助项目（项目编号：81673210）

The application of sellar dural suture technique in endoscopic transsphenoidal pituitary adenoma resection

LIU Zhi-yuan, ZHAO Liang, ZHANG Jia-yao, WANG Yu, LU Ai-lin, ZHAO Peng

Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China

Received:2021-03-31 Online:2021-04-25 Published:2021-04-27
Supported by:
This study was supported by the National Natural Science Foundation of China (No. 81673210).

摘要/Abstract

摘要：

目的总结鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用经验。方法以2018年10月至2019年11月行神经内镜下经鼻蝶入路垂体腺瘤切除术的患者为研究对象，于术中行鞍底硬脑膜缝合治疗脑脊液漏。结果肿瘤全切除率100%（25/25）；术中硬脑膜平均缝合时间24 min，其中后入组的15例患者平均15 min；脑脊液漏修补成功率达100%（25/25）。术后无再次脑脊液漏、无行腰大池引流术病例，2例因硬脑膜缺损行鼻黏膜瓣颅底重建，无一例患者发生围手术期感染或其他并发症。平均随访9.62个月，1例垂体催乳素腺瘤复发，无迟发性脑脊液漏和死亡病例。结论鞍底硬脑膜缝合技术安全、可靠，可在降低垂体腺瘤术后脑脊液漏发生率，减少自体脂肪、自体筋膜移植和带蒂鼻中隔黏膜瓣应用的同时，使相应并发症减少，值得临床推广。

关键词: 垂体肿瘤, 腺瘤, 脑脊液漏, 蝶鞍, 硬膜, 缝合技术, 神经内窥镜检查, 神经外科手术

Abstract:

Objective To summarize the experience of sellar dural suture technique in endoscopic transsphenoidal pituitary adenoma resection. Methods From October 2018 to November 2019, 25 patients with pituitary adenomas who underwent endoscopic transsphenoidal pituitary adenoma resection were selected. All of the 25 patients had cerebrospinal fluid (CSF) leakage during operation and underwent dural suture at the sellar floor. Results The total tumor resection rate was 100% (25/25). The dural suture time was 24 min in average, and the later 15 cases had an average time of 15 min. The successful rate of CSF leakage repair was 100% (25/25). There were no postoperative CSF leakage and lumbar cistern drainage. Two cases were repaired with nasal mucosal flap because of dural defect. No perioperative infection or other complications occurred. The average follow-up period was 9.62 months. One case of prolactinoma recurred and there was no delayed CSF leakage or death case. Conclusions Sellar dural suture is a safe and reliable technique to reduce the incidence of CSF leakage after pituitary adenoma surgery. It can reduce the application of autologous fat transplantation, autologous fascia transplantation and pedicled nasal septum mucosal flap, so as to reduce the occurrence of corresponding complications, which is worthy of clinical promotion.

Key words: Pituitary neoplasms, Adenoma, Cerebrospinal fluid leak, Sella turcica, Dura mater, Suture techniques, Neuroendoscopy, Neurosurgical procedures

刘志远, 赵亮, 章佳耀, 王宇, 鲁艾林, 赵鹏. 鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用[J]. 中国现代神经疾病杂志, 2021, 21(4): 324-328.

LIU Zhi-yuan, ZHAO Liang, ZHANG Jia-yao, WANG Yu, LU Ai-lin, ZHAO Peng. The application of sellar dural suture technique in endoscopic transsphenoidal pituitary adenoma resection[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(4): 324-328.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I4/324

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2 鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用

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2 鞍底硬脑膜缝合技术在神经内镜下经鼻蝶入路垂体腺瘤切除术中的应用

The application of sellar dural suture technique in endoscopic transsphenoidal pituitary adenoma resection

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