[1]李鹏涛,张能,王佳玲,等.垂体腺瘤经鼻蝶入路神经内镜切除术后颅内感染的危险因素[J].中国临床神经外科杂志,2022,27(07):548-550554.[doi:10.13798/j.issn.1009-153X.2022.07.006]
 LI Peng-tao,ZHANG Neng,WANG Jia-ling,et al.Risk factors for intracranial infection in patients with pituitary adenoma after endoscopic transsphenoidal surgery[J].,2022,27(07):548-550554.[doi:10.13798/j.issn.1009-153X.2022.07.006]
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垂体腺瘤经鼻蝶入路神经内镜切除术后颅内感染的危险因素()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年07期
页码:
548-550554
栏目:
论著
出版日期:
2022-07-31

文章信息/Info

Title:
Risk factors for intracranial infection in patients with pituitary adenoma after endoscopic transsphenoidal surgery
文章编号:
1009-153X(2022)07-0548-03
作者:
李鹏涛张能王佳玲禹文勇郝轶弘阿西木江·阿西尔周凯张庭荣李绍山
830054 乌鲁木齐,新疆医科大学第一附属医院神经外科(李鹏涛、张能、王佳玲、禹文勇、郝轶弘、阿西木江·阿西尔、周凯、张庭荣、李绍山)
Author(s):
LI Peng-tao ZHANG Neng WANG Jia-ling YU Wen-yong AXIMUJIANG Axier ZHOU Kai ZHANG Ting-rong LI Shao-shan
Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
关键词:
垂体腺瘤经鼻蝶入路神经内镜手术颅内感染危险因素
Keywords:
Pituitary adenoma Endoscopic transsphenoidal surgery Intracranial infection Risk factors
分类号:
R739.41;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2022.07.006
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切除术后发生颅内感染的危险因素。方法 回顾性分析2016年12月至2020年10月间经鼻蝶入路神经内镜手术切除的652例垂体腺瘤的临床资料,采用多因素logistic回归模型分析术后发生颅内感染的危险因素。结果 652例中,20例术后发生颅内感染,发生率为3.07%。多因素logistic回归分析显示,CSF漏(OR=5.845; 95% CI 1.334~25.613; P=0.019)、腰大池引流(OR=8.382;95% CI 1.807~38.874;P=0.007)、肿瘤直径>2 cm(OR=11.797;95% CI 1.395~99.727;P=0.023)、手术时间>3 h(OR=4.286;95% CI 1.005~18.279;P=0.049)、多次手术(OR=10.127;95% CI 1.334~25.613;P=0.019)、术后使用激素(OR=4.518;95% CI 1.301~15.686;P=0.018)是术后发生颅内感染的独立危险因素。结论 PA病人术后发生颅内感染,严重影响病人预后和手术效果;早期识别颅内感染的危险因素,采取适当的预防措施,对减少PA病人经鼻蝶入路神经内镜切除术后颅内感染,尤为重要。
Abstract:
Objective To analyze the risk factors for intracranial infection in the patients with pituitary adenoma (PA) after endoscopic transsphenoidal surgery (ETS). Methods The clinical data of 652 patients with PA who underwent ETS from December 2016 to October 2020 were retrospectively analyzed. The risk factors of intracranial infection were analyzed by multivariate logistic regression. Results The incidence of intracranial infection was 3.07% (20/652). Multivariate logistic regression analysis showed that cerebrospinal fluid leakage (OR=5.845; 95% CI 1.334~25.613; P=0.019), lumbar cistern drainage (OR=8.382; 95% CI 1.807~38.874; P=0.007), tumor diameter>2 cm (OR=11.797; 95% CI 1.395~99.727; P=0.023), operation time>3 h (OR=4.286; 95% CI 1.005~18.279; P=0.049), secondary operation (OR=10.127; 95% CI 1.334~25.613; P=0.019), and postoperative hormone use (OR=4.518; 95% CI 1.301~15.686; P=0.018) were independent risk factors for intracranial infection. Conclusions Postoperative intracranial infection has a serious impact on the prognoses and surgical outcomes of patients with PA. Early identification of risk factors for intracranial infection and appropriate preventive measures are essential for reducing intracranial infection in the patients with PA after ETS.

参考文献/References:

[1]Gittleman H, Ostrom QT, Farah PD, et al. Descriptive epidemiology of pituitary tumors in the United States, 2004-2009 [J]. J Neurosurg, 2014, 121: 527-535.
[2]Liu JK, Das K, Weiss MH, et al. The history and evolution of transsphenoidal surgery [J]. J Neurosurg, 2001, 95(6): 1083-1096.
[3]Conger A, Zhao F, Wang X, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients [J]. J Neurosurg, 2018, 130(3): 861-875.
[4]胡爱香,李 静,石月欣,等. 垂体瘤患者术后颅内感染影响因素与疾病负担分析[J]. 中华医院感染学杂志,2016,26(11):2488-2490.
[5]中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 现代实用医学,2003,15(7):460-465.
[6]Tsitsopoulos PP, Iosifidis E, Antachopoulos C, et al. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence [J]. Acta Neurochir (Wien), 2016, 158(9): 1647.
[7]曹 磊,李储忠,桂松柏,等. 神经内镜经鼻颅底外科术后颅内感染的危险因素分析[J]. 中华神经外科杂志,2019,35(4):334-338.
[8]Wang AJ, Zaidi HA, Laws ER. History of endonasal skull base surgery [J]. J Neurosurg Sci, 2016, 60(4): 441-453.
[9]Paluzzi A, Fernandez-Miranda JC, Stefko ST, et al. Endo-scopic endonasal approach for pituitary adenomas: a series of 555 patients [J]. Pituitary, 2014, 17(4): 307-319.
[10]董 燕,杜开先,张晓莉,等. 儿童开颅术后颅内感染多重耐药菌诊治分析[J]. 中国实用神经疾病杂志,2016,19(10):89-91.
[11]Nishioka H, Haraoka J, Ikeda Y. Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery [J]. Acta Neurochir (Wien), 2005, 147(11): 1163-1166.
[12]刘 崎,刘耀赛,李 军,等. 内镜下经鼻蝶垂体瘤切除术后脑脊液漏的危险因素分析[J]. 临床神经外科杂志,2020,17(5):516-521.
[13]黄敏东,江 楠,邹剑丹. 神经内镜下右侧单鼻孔经鼻蝶入路垂体瘤切除术中出现脑脊液漏的处理体会[J]. 中国实用医药,2021,16(18):35-37.
[14]Strickland BA, Lucas J, Harris B, et al. Identification and repair of intraoperative cerebrospinal fluid leaks in endonasal transsphenoidal pituitary surgery: surgical experience in a series of 1002 patients [J]. J Neurosurg, 2018, 129(2): 425-429.
[15]刘小海,金 雨,郭晓鹏,等. 鼻腔消毒对经蝶窦入路鼻腔定植菌的影响[J]. 中国医学科学院学报,2018,40(3):64-67.
[16]谢燕梅,陈伟明. 改良硬膜外导管连接装置持续腰大池引流术辅助治疗颅内感染临床效果[J]. 中华医院感染学杂志,2021,31(6):886-890.
[17]刘宏志,尹丽萍,冯 进. 内镜辅助下经鼻蝶入路垂体瘤切除术颅内感染因素分析及预防策略[J]. 立体定向和功能性神经外科杂志,2018,31(3):141-145.
[18]倪 健,吉 莉,钱晓英,等. 经鼻蝶窦入路垂体瘤切除术后并发颅内感染相关因素分析[J]. 中华医院感染学杂志,2018,28(12):1849-1851.
[19]Jin Y, Liu X, Gao L, et al. Risk factors and microbiology of meningitis and/or bacteremia after transsphenoidal surgery for pituitary adenoma [J]. World Neurosurg, 2018, 110: e851-e863.
[20]Mclaughlin N, Cohan P, Barnett P, et al. Early morning cortisol levels as predictors of short-term and long-term adrenal function after endonasal transsphenoidal surgery for pituitary adenomas and Rathke's cleft cysts [J]. World Neurosurg, 2013, 80(5): 569-575.

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备注/Memo

备注/Memo:
(2022-03-19收稿,2022-06-10修回)
基金项目:新疆维吾尔自治区自然科学基金(2022D01C244);新疆维吾尔自治区卫生健康青年医学科技人才专项(WJWY-202147)
通讯作者:李绍山,E-mail:45316016@qq.com
更新日期/Last Update: 2022-08-31