垂体大腺瘤经鼻手术中脑脊液漏病因分析及分级修补技术研究

打开文本图片集

【中图分类号】 R739.41 【文献标志码】 A 【文章编号】 1672-7770（2025）06-0662-06

Abstract： Objective To explore the clinical effect of individualized sellar floor reconstruction in different flowrate of cerebrospinal fluid leakage in endoscopicsurgery forpituitary macroadenoma. MethodsThe clinical data of 15O patients who underwent transnasal endoscopic resection of pituitary macroadenoma in the Department of Neurosurgery，the Afiliated Hospital of Xuzhou Medical University from January 2O16 to December 2O22 were analyzed retrospectively，and the occurrence of cerebrospinal fluid leakage was analyzed. The effects of individual selar floor reconstruction with diferent flow rates of cerebrospinal fluid leakage were analyzed. ResultsOf the 150 patients in this group，44 cases had cerebrospinal fluid leakage at all levels during the operation，accounting for 29.3% . The occurrence was related to pituitary apoplexy，Knosp highgrade，and waist cinch sign. There were 128 cases of no cerebrospinal fluid leakage and grade 1 cerebrospinal fluid leakage during the operation，of which 86 patients were repaired simply. Compared with 42 patients who used nasal septal mucosal flap，the incidence of postoperative cerebrospinal fluid leakage was lower and there was no significant difference. For 22 cases of grade 2 and 3 cerebrospinal fluid leakage during operation，1O cases were repaired with nasal septum mucosal flap. The incidence of postoperative cerebrospinal fluid leakage was significantly lower than that in the simple repair group.For the 52 cases with nasal septum mucosal flap repair，the complications such as hyposmia and nasal bleeding were higher than those with mucosal reduction. ConclusionsPituitary apoplexy，Knosp high-grade，and waist sign are independent risk factors for cerebrospinal fluid leakage during pituitary macroadenoma surgery. For patients with diferent flow rates during surgery，adopting different graded saddle reconstruction methods can effectively reduce the occurrence of postoperative cerebrospinal fluid leakage and reduce unnecessary nasal complications caused by the production of nasal septum mucosal flaps.

Key words： pituitary macroadenoma； neuroendoscopy；cerebrospinal fluid leakage；graded sellar floor reconstruction

内镜经鼻-蝶入路切除垂体腺瘤在鞍区病变治疗中的应用得到飞速发展，被认为是治疗垂体腺瘤和其他鞍区病变的有效方法[1]。（剩余9639字）