摘要：

目的 总结内镜下经鼻蝶入路治疗垂体腺瘤切除术后脑脊液鼻漏的临床体会。 方法 回顾分析采用内镜下经鼻蝶入路脑脊液鼻漏修补术治疗的16 例垂体腺瘤切除术后脑脊液鼻漏患者的临床资料，总结手术经验。 结果 16 例患者均采用内镜下经鼻蝶入路脑脊液鼻漏修补术，其中13 例（13/16）经首次脑脊液鼻漏修补术即成功，2 例（2/16）经再次修补术成功，1 例（1/16）改行开颅手术方修补成功。术后1 例出现颅内感染，予头孢曲松后痊愈。平均随访12 个月，无肿瘤和脑脊液鼻漏复发。 结论 内镜下经鼻蝶入路治疗垂体腺瘤切除术后脑脊液鼻漏安全、有效，值得临床推广应用。

关键词: 垂体肿瘤, 腺瘤, 蝶窦, 脑脊液鼻漏, 内窥镜检查

Abstract:

Objective  To summarize the experience of endoscopic surgery by transsphenoidal approach for repairing cerebrospinal fluid (CSF) rhinorrhea after pituitary adenoma resection.  Methods Clinical data, operation skills and follow-up data of 16 cases of persistent CSF rhinorrhea after pituitary adenoma resection from March 2009 to July 2014 were retrospectively analyzed.  Results  All patients were repaired by endoscopic transsphenoidal approach, 13 cases (13/16) were successful by one reparative surgery, 2 cases (2/16) were successful by the second repairment, and one case (1/16) was failed by several endoscopic surgeries, but was successfully repaired by craniotomy. One case presented intracranial infection after surgery, and recovered after taking ceftriaxone. After postoperative follow-up for 6 months to 2 years (average 12 months), no tumor recurrence or CSF rhinorrhea recurrence occurred.  Conclusions  Endoscopic transsphenoidal approach for repairing CSF rhinorrhea after pituitary adenoma resection was safe and effective. It can be widely used in clinic.

Key words: Pituitary neoplasms, Adenoma, Sphenoid sinus, Cerebrospinal fluid rhinorrhea, Endoscopy