垂体腺瘤经鼻蝶入路神经内镜切除术后脑脊液鼻漏的危险因素

目的 探讨垂体腺瘤经鼻蝶入路神经内镜切除术后脑脊液鼻漏的危险因素。方法 回顾性分析2016年1月至2019年3月经鼻蝶入路神经内镜手术治疗的130例垂体腺瘤的临床资料。结果 130例中，术后发生脑脊液鼻漏15例，发生率为11.5%（15/130）。多因素logistic回归分析发现，体质指数>25.0 kg/m2、术中脑脊液漏、再次手术是垂体腺瘤经鼻蝶入路神经内镜术后发生脑脊液漏的独立危险因素（P<0.05）。10例采用腰大池外引流，5例采用药物脱水治疗；15例未发生颅内感染情况；出院后随访12~36个月，未再次发生脑脊液鼻漏。结论 脑脊液鼻漏是PA经鼻蝶入路神经内镜切除术后较为常见的并发症，预后良好。对于体质肥胖、术中脑脊液漏和再次手术的PA，术后应密切关注脑脊液鼻漏和颅内感染情况，可考虑二次手术。

Risk factors for cerebrospinal fluid rhinorrhea in patients with pituitary adenoma after endoscopic transsphenoidal surgery

Objective To analyze the risk factors for cerebrospinal fluid (CSF) rhinorrhea in the patients with pituitary adenoma (PA) after endoscopic transsphenoidal surgery (ETS). Methods The clinical data of 130 patients with PA who underwent ETS from January 2016 to March 2019 were retrospectively analyzed. Results Postoperative CSF rhinorrhea occurred in 15 of 130 patients with PA, and the incidence rate was 11.5% (15/130). Multivariate logistic regression analysis showed that body mass index>25.0 kg/m2, intraoperative CSF leakage, and reoperation were independent risk factors for CSF rhinorrhea in the patients with PA after ETS (P<0.05). Ten patients reveived external lumbar drainage and 5 received drug treatment. No intracranial infection occurred in 15 patients with postoperative CSF rhinorrhea whose follow-up (range, 12~36 months) showed no recurrence of CSF rhinorrhea. Conclusions CSF rhinorrhea is a common complication of the patients after ETS, and the prognosis is good. For patients with obesity, intraoperative CSF leakage and reoperation, close attention should be paid to the CSF rhinorrhea and intracranial infection after surgery, and a second operation to repair the leak should be considered when necessary.