内镜经鼻蝶手术并发症

1992 年 Jankowski 等首次在内镜下行经鼻蝶

入路垂体瘤切除以来袁内镜经蝶尧扩大经蝶入路肿 瘤切除术日趋成熟袁广泛应用于垂体瘤尧脊索瘤等 颅底肿瘤的切除遥出血性血管损伤是该入路最严重 的并发症之一袁 现就本中心 2007 年 10 月 1 日至

单鼻孔内镜下经蝶尧扩大经蝶入路肿瘤切除术术中尧

术后出血原因分析及对策

李储忠袁 赵 澎袁 宗绪毅袁 桂松柏袁 刘方军袁 张亚卓

渊北京市神经外科研究所 / 首都医科大学附属北京天坛医院袁 北京 100050冤

揖摘要铱 背景与目的院 1992 年Jankowski 等首次在内镜下行经鼻蝶入路垂体瘤切除以来袁经过十几年的探索 和努力袁内镜经鼻蝶尧扩大经鼻蝶入路肿瘤切除术日趋成熟袁广泛应用于垂体瘤尧脊索瘤等颅底肿瘤的切除遥该术 式安全尧微创尧有效袁并发症的发生率远低于传统术式袁但出血性血管损伤是该术式最严重的并发症之一袁如处理 不当可明显影响患者预后袁本文将着重探讨该入路肿瘤切除术术中尧术后出血原因及对策遥方法院 对 111例单鼻 孔内镜下经蝶尧扩大经蝶入路肿瘤切除术病例进行回顾性分析袁其中垂体瘤 91例袁脊索瘤9例袁Rathe 囊肿5例袁 颅咽管瘤3例袁骨纤维结构不良 1例袁血管网状细胞瘤1例袁骨软骨瘤 1例遥 结果院 肿瘤全切 92例渊82.9%冤袁次 全切16例渊14.4%冤袁部分切除 3 例渊2.7%冤曰术中出血约 200ml 92 例渊82.9%冤袁跃 200ml 17 例渊15.3%冤袁跃 1000ml 2例 渊1.8%冤曰术后鼻衄 2例渊1.8%冤曰术后鞍上血肿 4 例渊3.6%冤遥 结论院 单鼻孔内镜下经蝶入路尧扩大经蝶入路肿瘤 切除术术中尧术后出血为该入路严重的并发症袁应通过正确操作尧及时处理避免其发生遥

关键词院 神经内镜曰 经鼻蝶入路曰 肿瘤曰 手术曰 出血 中图分类号: R739.41

文献标识码: A

文章编号:1726-8192渊2009冤01-0033-04

The Causes and Management of Hemorrhagic Complications

of Endoscopic Transsphenoidal and Extended

Transsphenoidal Surgery

Chu鄄 zhong Li, Peng Zhao, Xu鄄 yi Zong, Song鄄 bai Gui, Fang鄄 jun Liu, Ya鄄 zhuo Zhang

Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital

University of Medical Science, Beijing 100050, P.R. China

揖ABSTRACT 铱 BACKGROUND & OBJECTIVE: Endoscopic transsphenoidal and extended transsphenoidal

surgery have been accepted for the treatment of many kinds of skull base tumors. While complications may occur with this approach, among which the hemorrhagic vascular complications are the most serious. In this article, based on our experience, we will analyze these complications related to the surgical procedure and their management strategy. 酝耘 栽 匀韵阅 杂 院From October 2007 to October 2008, 111 patients who received endoscopic transsphenoidal or extended transsphenoidal surgery were analyzed, especially concerned the hemorrhagic vascular complications. 砸 耘 杂 哉 蕴 栽 院The patients whose volume of intraoperative bleeding 约 200ml were 92 cases (82.9%), 跃 200ml were 17 cases (15.3%), 跃 1000ml were 2 cases (1.8%冤. Postoperative epitasis occurred in 2 patients 渊1.8%冤and the supra-sellar hematomas occurred in 4 patients 渊3.6% 冤. 悦 韵晕 悦 蕴 哉 杂 陨 韵晕 杂 院The hemorrhagic complication is one of the most severe complications of the transsphenoidal surgery, but can be minimized with adequate preoperative preparation and

correct treatment algorithms for emergency situations.

运耘 再宰韵砸 阅 杂

院Neuroendoscope, Transsphenoidal surgery, Tumor, Surgery, hemorrhage 收稿日期院圆园园9-03-01 修回日期院圆园园9-03-08

通讯作者院 张亚卓

悦 燥 则 则 藻 泽 责燥 灶凿藻 灶糟 藻贼 燥 押 Ya鄄

zhuo Zhang 栽 藻 造 押 86鄄 10鄄

67022886 E鄄 mail: zyz2004520@. 窑专题窑

叶中国神经肿瘤杂志曳 圆园园9袁7渊1冤院33-36

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