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目的探讨大型及巨大型垂体腺瘤经蝶手术后发生脑脊液鼻漏的相关危险性因素。方法回顾性分析592例大型及巨大型垂体腺瘤病人的临床资料,均采取经蝶手术。结果术后发生脑脊液鼻漏26例。肿瘤大小、再次手术、肿瘤的质地和边缘与术后脑脊液鼻漏的发生相关;肿瘤的侵袭性、术前口服溴隐亭和肿瘤的切除程度与术后脑脊液鼻漏无关。脑脊液鼻漏的首次修补成功率为92.9%。26例脑脊液鼻漏病人中,5例发生脑膜炎;4例出现脑积水,行脑室-腹腔分流术缓解。结论巨大垂体腺瘤、再次手术、腺瘤的表面不光滑和质地韧者可能使发生术后脑脊液鼻漏的风险增加。经蝶手术入路是修补此类脑脊液鼻漏的最佳途径。
Objective To investigate the risk factors of cerebrospinal fluid rhinorrhea after transsphenoidal surgery in large and huge pituitary adenomas. Methods The clinical data of 592 patients with large and huge pituitary adenoma were retrospectively analyzed. All patients underwent transsphenoidal surgery. Results Cerebrospinal fluid rhinorrhea occurred in 26 cases. The tumor size, reoperation, tumor texture and margin were related to the occurrence of postoperative cerebrospinal fluid rhinorrhea. The invasiveness of the tumor, the preoperative oral bromocriptine and tumor resection degree had no relation with postoperative cerebrospinal fluid rhinorrhea. Cerebrospinal fluid rhinorrhea first repair success rate was 92.9%. In 26 cases of cerebrospinal fluid rhinorrhea patients, 5 cases of meningitis occurred; 4 cases of hydrocephalus, intraventricular - peritoneal shunt to ease. Conclusion The huge pituitary adenoma, reoperation, adenoma surface is not smooth and tough texture may make the occurrence of postoperative cerebrospinal fluid rhinorrhea increased risk. Transsphenoidal approach is the best way to repair such cerebrospinal fluid rhinorrhea.