神经内镜下垂体瘤切除术的并发症及其相关危险因素分析

发布时间：2018-06-08 04:11

本文选题：垂体瘤 + 并发症　；参考：《浙江大学》2017年硕士论文

【摘要】：目的分析总结神经内镜下经鼻蝶入路垂体瘤切除术的并发症及其相关危险因素,为减少术后并发症的发生提供理论依据与指导。方法收集浙江大学医学院附.属第二医院神经外科在2016年1月1日至2016年12月31日期间收治并行神经内镜下经鼻蝶入路垂体瘤切除术的患者共114例,对患者临床资料进行回顾性分析,总结术后并发症,分别对患者的年龄、性别、体重指数、高血压、糖尿病、吸烟史、饮酒史、术前视力障碍、术前内分泌紊乱、肿瘤大小、手术时间、术中出血量、术中脑脊液漏、再次手术14个指标行统计学分析,寻找其中与术后并发症相关的危险因素。结果总共114例纳入研究的神经内镜下垂体瘤切除术患者中,术后发生并发症者70例(61.4%),其中出现脑脊液鼻漏10例(8.8%),颅内感染5例(4.4%),低钠血症29例(25.4%),垂体功能低下16例(14.0%),尿崩症46例(40.4%),鼻出血4例(3.5%),脑梗死1例(0.9%),肺炎1例(0.9%)。通过单因素统计学分析并未发现与内镜下垂体瘤切除术后发生并发症显著相关的危险因素;然而亚组分析发现,手术时间长(≥3小时)是发生脑脊液鼻漏的潜在危险因素,吸烟史和饮酒史是发生颅内感染的潜在危险因素,年龄55岁和手术时间长(≥3小时)是发生尿崩症的的潜在危险因素;Logistic回归分析显示,手术时间长(≥3小时)是术后发生尿崩症的危险因素。结论颅内感染、低钠血症、垂体功能低下、脑脊液鼻漏、尿崩症、鼻出血等是神经内镜下垂体瘤切除术的常见并发症。手术时间长(≥3小时)是术后发生尿崩症的危险因素。
[Abstract]:Objective to analyze and summarize the complications and related risk factors of endoscopic transsphenoidal pituitary adenoma resection in order to provide theoretical basis and guidance for reducing the incidence of postoperative complications. Methods collected from the Medical College of Zhejiang University, affiliated to the Department of Neurosurgery of the second hospital from January 1, 2016 to December 31, 2016, were treated with parallel neuroendoscopy. A total of 114 patients with pituitary adenoma underwent transsphenoidal approach. The clinical data were retrospectively analyzed. The postoperative complications were reviewed. The patients' age, sex, body mass index, hypertension, diabetes, smoking history, drinking history, preoperative visual impairment, preoperative internal secretory disorder, tumor size, operation time, intraoperative bleeding, and intraoperative spinal cord were analyzed. A total of 114 cases included 70 cases (61.4%) of postoperative complications, including 10 cases of cerebrospinal fluid rhinorrhea (8.8%), 5 cases of intracranial infection (4.4%), 29 cases of hyponatremia (25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, 25.4%, and 25.4% There were 16 cases of hypophysis dysfunction (14%), 46 cases of diabetes insipidus (40.4%), 4 cases of nasal hemorrhage (3.5%), 1 cases of cerebral infarction (0.9%), 1 cases of pneumonia (0.9%). The risk factors that were significantly related to the complications after endoscopic pituitary adenoma resection were not found by single factor analysis. However, the subgroup analysis found that the operation time was longer (more than 3 hours) was the occurrence of the spinal cord. The potential risk factors of liquid rhinorrhea, smoking history and drinking history are potential risk factors for intracranial infection. Age 55 years and long operation time (more than 3 hours) are potential risk factors for diabetes insipidus. Logistic regression analysis shows that the long operation time (> 3 hours) is a risk factor for postoperative diabetes insipidus. Conclusion intracranial infection, low sodium Hypothyroidism, hypophysis dysfunction, cerebrospinal fluid rhinorrhea, diabetes insipidus, nasal bleeding, etc. are common complications of pituitary adenoma resection under neuroendoscopy. The long operation time (more than 3 hours) is a risk factor for postoperative diabetes insipidus.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

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