垂体腺瘤经鼻蝶入路术后出血的原因及防治.pdf

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1、中华神经外科疾病研究杂志(ChinJNeurosurgDisRes)2015：14(3·251·文章编号：1671—2897(2015)14—251—04·论著·垂体腺瘤经鼻蝶人路术后出血的原因及防治梁强陈菊祥骆纯胡国汉严勇徐涛钱俊蒋磊卢亦成(第二军医大学长征医院神经外科，上海200003)摘要目的探讨经鼻蝶入路垂体腺瘤切除术后出血的原因、防治以及预后。方法回顾分析我院神经外科876例经鼻蝶入路切除垂体腺瘤患者中17例术后并发出血患者的临床资料，并结合文献加以讨论。结果11例鞍内出血患者中6例为残瘤出血

2、所致，5例与鞍内填塞物过多有关；其中9例行经蝶手术清除血肿，7例视力恢复正常，2例遗留单侧视力障碍。6例鞍上出血患者中4例为残留肿瘤出血经破裂鞍膈进入颅内所致，2例与术中鞍膈短时间较大幅度下降有关，该6例均行开颅手术清除血肿，意识和视力恢复各1例，死亡1例，余3例长期昏迷。结论垂体腺瘤术后无论是鞍上还是鞍内出血都是严重的并发症，鞍内出血只要及时发现和处理一般预后良好。鞍上出血常提示预后不良，须以预防为主。关键词经鼻蝶人路手术；垂体腺瘤；出血中国图书资料分类号R739．41文献标识码APost-opera

3、tivehemorrhage8ftertranssphenoidalsurgeryinpatientswinlpitmtaryadenon~：aret~veanalysisHANGQ，CHEN，，LUOChun，HUGuohan，YANYong，XUTao，QtANJun，JIANGLei，LU~chengDepartmentofNeurosurgery，Chan~zhengHospital，SecondMilitaryMedicalUniversity，喇2OOO08，ChinaAbstractObj

4、ectiveThepossiblecauses，managementandprognosisofpost·operativehemorrhageaftertranssphenoidalsurgeryinpatientswithpituitaryadenomaarediscussed．MethodsAmong876consecu~vecasesWithpituitaryadenomaundergone~anssphenoidalsurgery．post—operativehemorrhageoccurre

5、din17eases．Thechnicaldatawereanalyzedretrospectivelyanddiscussedwiththerelmedliteratures．ResultsInall11easeswitllintrasellahemorrhage，sixhemorrhagiceaseswereduetoresidualtumorbleedingand5easesduetointrasellaoverpackingofhemostasismaterials．InnineCasesund

6、erwenthematomaevacuation，7easesgotgoodrecoveryofvisualacuityand2easesremainedunilateralvisualimpairment．Foureaseswererelatedtoresidualtumorbleedingintosubarachnoidalspacethroughtheruptureddiaphragmaseliaeand2casesprobablyrelatedtorapidcollapseofdiaFsella

7、eintra·operativelyin6caseswithsuprasellahemorrhage．ThehematomaevacuationbycraniotomyWereperformedinall6cases，and1easegotrecoveryofvisualacuity，1casegotcompleterecoveryofconsciousness，1deadcaseand3Casesremainedcomastatus．ConclusionBothpost—operativeintras

8、ellaandsuprasellahemorrhageaftertranssphnoidalsurgeryforpituitaryadenomasshouldbeconsideredasseverecomplicationsandneedappropriatemanagementassoonaspossible．Patientswithintrasellahemorhageoftenhavefavorableprognosisafterpr