[1]张溢华、谭 杨、王 昊、陈立朝、贺绪智、梁 鸿、许民辉、徐伦山.游离中鼻甲粘膜瓣在经鼻蝶入路神经内镜手术切除垂体腺瘤后鞍底重建中的应用…[J].临床神经外科杂志,2019,16(04):390-392.[doi:10.13798/j.issn.1009-153X.2019.07.003]
 ZHANG Yi-hua,TAN Yang,WANG Hao,et al.Application of free middle turbinate mucosal flaps to reconstruction of sellar floors in endoscopic transnasal transsphenoidal surgery in patients with pituitary adenomas[J].Journal of Clinical Neurosurgery,2019,16(04):390-392.[doi:10.13798/j.issn.1009-153X.2019.07.003]
点击复制

游离中鼻甲粘膜瓣在经鼻蝶入路神经内镜手术切除垂体腺瘤后鞍底重建中的应用…()
分享到:

《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
16
期数:
2019年04期
页码:
390-392
栏目:
论著
出版日期:
2019-08-15

文章信息/Info

Title:
Application of free middle turbinate mucosal flaps to reconstruction of sellar floors in endoscopic transnasal transsphenoidal surgery in patients with pituitary adenomas
文章编号:
1009-153X(2019)07-0390-03
作者:
张溢华、谭 杨、王 昊、陈立朝、贺绪智、梁 鸿、许民辉、徐伦山
400042 重庆,陆军军医大学大坪医院神经外科
Author(s):
ZHANG Yi-hua TAN Yang WANG Hao CHEN li-zhao HE Xu-zhi LIANG Hong XU Min-hui XU Lun-shan. Department of Neurosurgery Daping Hospital Army Medical University PLA Chongqing 400042 China
Daping Hospital, Army Medical University, PLA, Chongqing 400042, China
关键词:
垂体腺瘤神经内镜经鼻蝶入路游离中鼻甲粘膜瓣鞍底重建
Keywords:
Pituitary adenomas Endoscopic endonasal transsphenoidal surgery Free middle turbinate mucosal flap Sellar floor reconstruction
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.07.003
文献标志码:
A
摘要:
目的 探讨游离中鼻甲粘膜瓣在经鼻蝶入路神经内镜手术治疗垂体腺瘤鞍底重建中的方法及应用价值。方法 回顾性分析2017年6月至 2018年6月经鼻蝶入路神经内镜手术治疗的45例直径1~2.5 cm的垂体腺瘤的临床资料。经单鼻孔手术25例(单鼻孔组),双鼻孔手术20例(双鼻孔组)。术中均采用游离中鼻甲粘膜瓣重建鞍底。结果 肿瘤均全切除。术后随访 6个月,两组均未出现脑脊液漏和颅内感染,均无鼻腔干燥、异味等鼻部并发症;单鼻孔组术后嗅觉障碍发生率(16.0%,4/25)明显低于双鼻孔组(90.00%,18/20;P<0.05)。结论 对于直径1~2.5 cm的垂体腺瘤,经鼻蝶入路神经内镜手术中鞍底缺损直径约2 cm,采用游离中鼻甲粘膜瓣进行鞍底重建,可有效预防脑脊液漏、颅内感染,单鼻孔组术后嗅觉障碍发生率较双鼻孔组低。
Abstract:
Objective To explore the method to reconstruct the sellar floors with free middle turbinate mucosal flaps in the endoscopic transnasal sphenoidal surgery and its value in the patients with pituitary adenomas. Methods The clinical data of 45 patines with pituitary adenomas 1~2.5 cm in diameter treated by endoscopic transsphenoidal surgery from June, 2017 to June, 2018 were analyzed retrospectively. Of these 45 patients, 25 underwent endoscopic transsphenoidal surgery through single nostril approach (single nostril group) and 20 through double nostrils approach (double nostrils group). The sellar floors were intraoperatively reconstructed with free middle turbinate mucosal flaps in all the patients. Results The following-up 6 months after the operation showed that there were no complications such as cerebrospinal fluid (CSF) leakage and intracranial infection, dry nasal cavity and abnormal odor. The rate of olfactory hypoesthesia (16%, 4/25) was significantly lower in the single nostril group than that (90%, 18/20) in the double nostrils group (P<0.05). Conclusions The reconstruction of the sellar floors with free middle turbinate mucosal flaps is an effective and safe method to prevent the postoperative complications such as CSF leakage and intracranial infection in the patients with pituitary adenomas 1~2.5 cm in diameter and sellar floor defect some 2 cm in diameter. The patients with pituitary adenomas undergoing endoscopic transsphenoidal surgery through the single nostril approach have significantly low incidence of postoperative olfactory hypoesthesia compared with the patients through the double nostrils approach.

参考文献/References:

[1] Ostrom Q, Gittleman H, Farah P, et al. CBTRUS statistical report: Primary brain and central nervous systemtumors diagnosed in the United States in 2006-2010 [J]. Neuro Oncol, 2013, 15(suppl 2): e1-e56. [2] Schmidt RF, Choudhry OJ, Takkellapati R, et al. Hermann Schloffer and the origin of transsphenoidal pituitary surgery [J]. Neurosurg Focus, 2012, 33(2): e5-e15. [3] Singh H, Essayed WI, Cohen-Gadol A, et al. Resection of pituitary tumors: endoscopic versus microscopic [J]. J Neuro Oncol, 2016, 130(2): 309-317. [4] 徐 涛,彭 林,李 昊,等. 我国内镜对比显微镜下垂体 瘤切除术的更新及累积荟萃分析[J]. 中华医学杂志, 2015,95(41):3378-3381. [5] Magro E, Graillon T, Lassave J, et al. Complications related to the endoscopic endonasal transsphenoidalapproach for nonfunctioning pituitary macroadenomas in 300 consecutive patients [J]. World Neurosurg, 2016, 89(5): 442-453. [6] 高 飞,衡立君,贾 栋,等. 神经内镜下经鼻蝶垂体腺 瘤切除术中鞍底重建[J]. 中国临床神经外科杂志,2014, 19(7):403-405. [7] Almeida JRD, Snyderman CH, Gardner PA, et al. Nasal morbidity following endoscopic skull base surgery: a pro- spective cohort study [J]. Head Neck, 2011, 33: 547-551. [8] Markey J, Benet A, Elsayed IH. The endonasal endoscopic harvest and anatomy of the buccal fat pad flap for closure of skull base defects [J]. Laryngoscope, 2015, 125(10): 2247- 2252. [9] Scangas GA, Remenschneider AK, Bleier BS, et al. Does the timing of middle turbinate resection influence quality-of- life outcomes for patients with chronic rhinosinusitis [J]? Otolaryngol Head Neck Surg, 2017, 157(5): 739-742. [10] Liebelt BD, Huang M, Baskin DS. Sellar floor reconstruction with the medpor implant vs. autologous bone following transnasal transsphenoidal surgery: outcome in 200 conse- cutive cases. [J]. World Neurosurg, 2015, 84(2): 240-245. [11] 杨智君,周强意,王振民,等. 鼻内镜下切除垂体腺瘤术中 脑脊液漏的分级及处理[J]. 中国现代医生,2016,54 (36):56-58. [12] Miller AJ, Bobian M, Peterson E, et al. Bleeding risk asso- ciated with resection of the middle turbinate during func- tional endoscopic sinus surgery [J]. Am J Rhinolo Allergy, 2016, 30(2): 140-142. [13] Majovsky M, Astl J, Kovar D, et al. Olfactory function in patients after transsphenoidal surgery for pituitary adenomas a short review [J]. Neurosurg Rev, 2018, 10(1): 1-7. [14] 汤 浩,卫永旭,杨文磊,等. 神经内镜下经鼻-蝶窦垂体 瘤切除入路改进及效果分析[J].中华医学杂志,2018,98 (37):3021-3025.

相似文献/References:

[1]佘磊,李育平,张恒柱,等.神经内镜锁孔入路与传统开颅术治疗颅内血肿的对比研究[J].临床神经外科杂志,2014,(01):33.
[2]徐成伟,朱宏伟,高乃康,等.142例鞍区占位病变手术治疗总结[J].临床神经外科杂志,2014,(01):51.
[3]马俊伟,蒋栋毅,陈寒春,等.神经内镜下经鼻蝶入路垂体腺瘤手术切除的临床疗效分析[J].临床神经外科杂志,2015,(01):48.
[4]荣道建,杨晓健,赵俊伟.神经内镜辅助原发性三叉神经显微血管减压术[J].临床神经外科杂志,2015,(02):89.
[5]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,(04):265.
[6]李强,许琼冠,刘达远,等.缺氧诱导因子-1α、血管内皮细胞生长因子在垂体腺瘤中的表达及其意义[J].临床神经外科杂志,2015,(05):363.
[7]张元隆,江常震,王晨阳.经额开颅手术后额窦炎的处理[J].临床神经外科杂志,2015,(05):380.
[8]耿鑫.CT引导内窥镜立体定向术治疗颅内病变的临床研究[J].临床神经外科杂志,2014,(02):122.
[9]陈旭东,朱美晓,成力伟,等.微骨孔入路神经内镜下超早期治疗脑出血疗效研究[J].临床神经外科杂志,2014,(03):197.
[10]段海锋,范月超.转录因子YY1对垂体瘤侵袭性的影响[J].临床神经外科杂志,2014,(06):416.
[11]张红波,陈谦学,穆林森.斜坡异位泌乳素垂体腺瘤1例临床分析并文献复习[J].临床神经外科杂志,2016,(01):16.
[12]惠卫宁,邵国平,黄炜,等.神经内镜下垂体腺瘤假包膜切除的临床、病理研究[J].临床神经外科杂志,2018,15(04):308.
 HUI Wei-ning,SHAO Guo-ping,HUANG Wei,et al.Clinical and pathological study on resection of pseudocapsule of pituitary adenoma by neuroendoscopy[J].Journal of Clinical Neurosurgery,2018,15(04):308.
[13]周腾渊,陈来照,牛小敏,等.经鼻蝶入路神经内镜下垂体瘤切除术的疗效研究[J].临床神经外科杂志,2019,16(2):134.[doi:10.3969/j.issn.1672-7770.2019.02.009]
 ZHOU Teng-yuan,CHEN Lai-zhao,NIU Xiao-min,et al.Clinical analysis of endoscopic transsphenoidal pituitary adenoma resection[J].Journal of Clinical Neurosurgery,2019,16(04):134.[doi:10.3969/j.issn.1672-7770.2019.02.009]

备注/Memo

备注/Memo:
(2019-01-10收稿,2019-03-1修回)通讯作者:徐伦山:E-mail:xuliu559@163.com
更新日期/Last Update: 1900-01-01