[1]周猛,刘彦廷,田春雷,等.垂体腺瘤经鼻蝶入路神经内镜术后早期并发脑脊液鼻漏的影响因素[J].中国临床神经外科杂志,2023,28(12):701-704.[doi:10.13798/j.issn.1009-153X.2023.12.008]
　ZHOU Meng,LIU Yan-ting,TIAN Chun-lei,et al.Risk factors of early cerebrospinal fluid rhinorrhea in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery[J].,2023,28(12):701-704.[doi:10.13798/j.issn.1009-153X.2023.12.008]
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垂体腺瘤经鼻蝶入路神经内镜术后早期并发脑脊液鼻漏的影响因素()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年12期
页码:
701-704
栏目:
论著
出版日期:
2023-12-31

文章信息/Info

Title:
Risk factors of early cerebrospinal fluid rhinorrhea in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery
文章编号:
1009-153X（2023）12-0701-04
作者:
周猛; 刘彦廷; 田春雷; 雷志恒; 罗然
443003湖北宜昌，三峡大学第一临床医学院/宜昌市中心人民医院神经外科（周猛、刘彦廷、田春雷、雷志恒、罗然）
Author(s):
ZHOU Meng;  LIU Yan-ting;  TIAN Chun-lei;  LEI Zhi-heng;  LUO Ran
The First College of Clinical Medical Science, China Three Gorges University & Department of Neurosurgery, Yichang Central People's Hospital, Yichang 443003, China
关键词:
垂体腺瘤; 脑脊液鼻漏; 经鼻蝶入路; 神经内镜; 影响因素
Keywords:
Pituitary adenomas;  Cerebrospinal fluid rhinorrhea;  Endoscopic endonasal transsphenoidal surgery;  Risk factors
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2023.12.008
文献标志码:
A
摘要:
目的 探讨垂体腺瘤经鼻蝶入路神经内镜术后早期（1周）并发脑脊液鼻漏的影响因素。方法 回顾性分析2017年1月至2022 年1月经鼻蝶入路神经内镜手术治疗的246例垂体腺瘤的临床资料。术后1周内鼻腔漏出液葡萄糖>1.7 mmol/L诊断为脑脊液鼻漏。结果 246 例中，术后早期发生脑脊液鼻漏30例，发生率为12.2%。多因素logistic回归分析显示，肿瘤质地韧（OR=4.013；95% CI 1.289~12.497；P=0.017）、肿瘤上下径大（OR=1.149；95% CI 1.039~1.271；P=0.007）、术中脑脊液漏（OR=26.425；95% CI 7.034~99.278；P=0.001）是术后早期并发脑脊液鼻漏的独立危险因素，而使用带血管蒂鼻中隔粘膜瓣修补颅底（OR=0.026；95% CI 0.003~0.261；P=0.002）是术后早期并发脑脊液鼻漏的保护因素。与术中1级脑脊液漏病人（47.2%，17/36）比较，术中0级（5.3%，10/188）、2级（16.7%，2/12）、3级（10.0%，1/10）脑脊液漏病人发生术后早期脑脊液鼻漏几率明显降低（P<0.05）；而术中0级、2级、3级脑脊液漏病人之间均无统计学差异（P>0.05）。结论 经鼻蝶入路神经内镜手术切除垂体腺瘤时，肿瘤质地较韧、肿瘤上下径较大和术中脑脊液漏会增加术后早期脑脊液鼻漏的风险，临床应引起重视；而使用带血管蒂鼻中隔黏膜瓣修补颅底会减少术后早期脑脊液鼻漏的发生率。
Abstract:
Objective To investigate the risk factors of early (1 week) cerebrospinal fluid rhinorrhea (CFR) in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery (EETS). Methods The clinical data of 246 patients with pituitary adenomas treated by EETS from January 2017 to January 2022 were retrospectively analyzed. CFR was diagnosed with glucose >1.7 mmol/L in the leaking fluid within 1 week after surgery. Results Of these 246 patients, 30 patients (12.2%) suffered from early CFR after operation. Multivariate logistic regression analysis showed that the texture of tumor (OR=4.013; 95% CI 1.289~12.497; P=0.017), large upper and lower diameter of tumor (OR=1.149; 95% CI 1.039~1.271; P=0.007), and intraoperative cerebrospinal fluid leakage (ICFL) (OR=26.425; 95% CI 7.034~99.278; P=0.001) were independent risk factors for early CFR, while the use of vascularized nasal septum mucosal flap to repair skull base (OR=0.026; 95% CI 0.003~0.261; P=0.002) was a protective factor for early CFR. Compared with patients with grade 1 ICFL (47.2%, 17/36), the rates of early CFR in grade 0 patients (5.3%, 10/188), grade 2 patients (16.7%, 2/12), and grade 3 patients (10.0%, 1/10) significantly decreased (P<0.05). There was no significant difference in the rates of early CFR among grade 0, grade 2 and grade 3 patients (P>0.05). Conclusions For patients with pituitary adenomas undergoing EETS, the risk of early CFR is increased in patients with tough texture tumors, larger diameter of the upper and lower part of the tumors and the ICFL, while the use of vascular pedicled nasal septum mucosal flap to repair the skull base can reduce the incidence of early CFR.

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备注/Memo

备注/Memo:
（2023-05-16收稿，2023-08-09修回）
基金项目：宜昌市医疗卫生研究项目（A20-2-011）
通讯作者：罗　然，E-mail：lrns2005@163.com
更新日期/Last Update: 2023-12-31