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神经内镜经鼻蝶切除垂体腺瘤患者脑脊液漏的影响因素分析

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成果类型:
期刊论文
论文标题(英文):
Risk factors of cerebrospinal fluid leak in endoscopic endonasal transsphenoidal pituitary surgery
作者:
王明;彭雍;蒋宇钢
作者机构:
[王明; 彭雍; 蒋宇钢] 中南大学湘雅二医院神经外科
语种:
中文
关键词:
垂体肿瘤;神经外科手术;脑脊液鼻漏;影响因素分析
关键词(英文):
Pituitary neoplasms;Neurosurgical procedures;Cerebrospinal fluid rhinon'hea;Root cause analysis
期刊:
中华神经外科杂志
期刊(英文):
Chinese Journal of Neurosurgery
ISSN:
1001-2346
年:
2018
卷:
34
期:
3
页码:
277-281
机构署名:
本校为第一机构
院系归属:
湘雅二医院(第二临床学院)
摘要:
目的探讨影响垂体腺瘤患者在神经内镜下经鼻蝶入路手术中及手术后发生脑脊液漏的影响因素。方法回顾性分析中南大学湘雅二医院神经外科2011 1月至2017年6月连续收治的112例垂体腺瘤患者的临床资料,对所有患者均行神经内镜经鼻蝶入路手术。采用单因素和多因素Logistic回归方法分析影响患者术中、术后早期(术后≤7 d)和术后晚期(术后>7 d)出现脑脊液漏的因素。结果112例患者中,33.0% (37/112)的患者术中出现脑脊液漏,9.8% (11/112)术后早期出现脑脊液漏,6.3%(7/112)术后晚期出现脑脊液漏。单因素和多因素分析结果显示肿瘤直径(OR =1.090,95% 1.156,P =0.004 )是影响患者术中出现脑脊液漏的危险因素;麻醉分级(OR=4.920,95%CI:1.360 ~ 17.808,P = 0,015)是影响患者术后早期出现脑脊漏的危险因素,而带血管修补(OR=0.100,95%CI:0.012 ~ 0.841,P=0.034)是其保护因素;慢性呼吸系统疾病(OR=68.667,95%CI;8.848~532.925,P<0.001)是影响患者术后晚期出现脑脊液漏的危险因素。结论神经内镜经鼻蝶入路切除垂体腺瘤,肿瘤体积越大,越易发生术中脑脊液漏;麻醉分级越高,越易发生术后早期脑脊液漏,带血管蒂黏膜瓣修补能使术后早期脑脊液漏的危险性降低;有慢性呼吸道疾病的患者易发生术后晚期脑脊液漏。
摘要(英文):
Objective To explore the risk factors of intraoperative and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal transsphenoidal pituitary surgery. Methods A retrospective analysis was conducted on clinical data of 112 cases of pituitary adenomas admitted to Neurosurgery Department at the Second Xiangya Hospital of Central South University from January 2011 to June 2017. All pituitary adenomas were treated through endoscopic endonasal transsphenoidal approach. The risk factors of intraoperative, early postoperative ( within 7 days post surgery) and late postoperative (7 days post surgery) CSF leaks were explored by univariate and multivariate logistic regression analysis. Results In this series, intraoperative CSF leaks occurred in 33.0% (37/112) of the patients, early postoperative CSF leaks in 9.8% (11/112), and late postoperative CSF leaks in 6.3% (7/112) of the eases. Univariate and multivariate logistic regression analysis showed that tumor size was the risk factor for intraoperative CSF leak ( OR = 1. 090, 95% CI: 1. 027 - 1. 156, P = 0. 004) ; ASA ( American Society of Anesthesiologists) score was the risk factor of postoperative early CSF leak ( OR = 4. 920, 95% CI: 1. 360 - 17. 808, P = 0. 015 ) ; vascularized septal mucosal flap was the protective factors for early postoperative CSF leak ( OR = 0. 100, 95% CI: O. 012 - 0. 841, P = 0. 034) ; CRD ( chronic respiratory disease) was the risk factor of late postoperative CSF leak ( OR = 68. 667, 95% CI: 8. 848 - 532. 925, P 〈 0. 001 ). Conclusions For endoscopic endonasal transsphenoidal pituitary surgery, patients with large pituitary adenomas are more likely to develop intraoperative CSF leaks. Higher ASA score is associated to greater chance of early postoperative CSF leaks, while vascularized septal mucosal flaps could reduce its risk. CRD might be correlated with late postoperative CSF leaks.

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