巨大垂体腺瘤经蝶手术后发生脑脊液鼻漏的危险因素分析

目的：探讨巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病原因，并提出相关的修补措施。方法：选择2009 年2 月-2012年8 月在我院进行诊治的巨大垂体腺瘤患者180 例，所有患者均采用经蝶手术摘除巨大垂体腺瘤。观察预后情况。结果：在接受经蝶手术的180 例患者中，25例发生脑脊液鼻漏，发生率为13.8%。其中男性15例，女性10例。单因素多因素分析都显示肿瘤大小、慢性蝶窦炎与再次手术与脑脊液鼻漏的发生有直接关系，为独立的影响因素（P〈0.05）。对25 例出现脑脊液鼻漏的患者采用鼻内镜手术进行治疗，全部病例经手术修复后获得一次性治愈。随访6个月，无1例复发，无术后并发症。结论：巨大垂体腺瘤经蝶手术脑脊液鼻漏的发病率比较高，肿瘤大小、慢性蝶窦炎与再次手术为主要的独立危险因素，要积极采用鼻内镜下治疗。

Analysis of Risk Factors on Cerebrospinal Fluid Rhinorrhea after the Treatment of Giant Pituitary Adenomas by Transsphenoidal Surgery

Objective： To analyze the risk factors on the cerebrospinal fluid rhinorrhea after the treatment of giant pituitary adenomas by transsphenoidal surgery, and to put forward the relevant remedial measures for clinical. Methods： 180 patients with giant pituitary adenomas who were diagnosed and treated by transsphenoidal surgery in our hospital from February 2009 to August 2012 were selected, and the prognosis of patients were observed and analyzed. Results： CSF fistula occurred in 25 cases, the rate was 13.8%, including 15 males and 10 females. Univariate Multivariate analysis showed that the tumor size, chronic sphenoid sinusitis and reoperation occurred with cerebrospinal fluid rhinorrhea which was directly related to the impact of independent factors （P〈0.05）. The patients with CSF fistu- las were treated by endoscopic surgery. And all the patients got recovery after the surgery. After six-month＇s follow-up, there was no re- currence or postoperative complications. Conclusion： Giant pituitary adenomas by transsphenoidal surgery cerebrospinal fluid rhinorrhea had relatively high incidence, tumor size, chronic sphenoid sinusitis with reoperation as a major independent risk factor, which should ac- tively adopt endoscopic treatment.