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目的探讨经鼻蝶入路垂体腺瘤切除术中和术后并发颈内动脉损伤的预防、诊断及治疗原则。方法4例施行经鼻蝶入路垂体腺瘤切除术的患者均并发颈内动脉损伤,其中颈内动脉破裂出血2例,颈内动脉假性动脉瘤1例,颈内动脉海绵窦瘘1例。结果2例颈内动脉破裂出血患者,分别经颈内动脉球囊栓塞术和颈内动脉腔内覆膜支架植入术完全闭塞破裂口,手术后均未再出现新的神经功能障碍。其余2例患者也分别经颈内动脉腔内覆膜支架植入术和海绵窦瘘球囊栓塞术治愈。结论经鼻蝶入路垂体腺瘤切除术中并发的颈内动脉损伤是一严重的手术并发症,可通过手术前影像学检查、手术中准确定位加以预防;脑血管造影检查可及时显示颈内动脉损伤的类型和部位,并通过颈内动脉球囊栓塞术和腔内覆膜支架植入术进行治疗。
Objective To investigate the prevention, diagnosis and treatment of intra-arteria carotis artery injury during and after pituitary adenoma resection. Methods 4 cases of patients undergoing transnasal pituitary adenoma resection were complicated with internal carotid artery injury, including 2 cases of internal carotid artery rupture, 1 case of internal carotid artery pseudoaneurysm, 1 case of internal carotid cavernous fistula . Results In 2 patients with internal carotid artery rupture hemorrhage, they were completely occluded and ruptured through carotid artery balloon embolization and endovascular stent graft respectively. No new neurological dysfunction occurred after operation. The remaining 2 patients were also treated by endovascular stent graft and cavernous sinus fistula balloon embolization. Conclusions The internal carotid artery injury complicated by nasalis pituitary adenoma resection is a serious complication of surgery, which can be prevented by preoperative imaging and precise positioning during operation. Cerebral angiography can show the internal The type and site of arterial injury were treated by balloon occlusion of the internal carotid artery and endovascular stent-graft.