Application of ethmoid artery pedicled septal floor mucosa flap in repair of postoperative cerebrospinal fluid leak after transsphenoidal pituitary surgery
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摘要: 目的 探讨采用以筛动脉为蒂的鼻中隔鼻底黏膜瓣修复经蝶垂体瘤术后脑脊液漏的安全性及有效性。方法 回顾上海交通大学医学院附属上海市第六人民医院耳鼻咽喉头颈外科2011年6月—2022年6月收治的6例垂体瘤术后脑脊液漏患者的临床资料，因既往手术采用内镜经蝶扩大入路破坏了双侧鼻中隔后动脉，手术采用以筛动脉为蒂的鼻中隔鼻底黏膜瓣进行修补。结果 6例患者术后随访黏膜瓣均生长良好，未再发生脑脊液漏。结论 垂体瘤术后的高流量脑脊液漏临床修复困难，对于经蝶入路破坏双侧鼻中隔后动脉的患者，其经典的鼻中隔后动脉黏膜瓣不可用，以筛动脉为蒂的鼻中隔鼻底黏膜瓣是可选择的方法之一。Abstract: Objective To investigate the safety and effectiveness of the ethmoid artery pedicled septal floor mucosal flap in repair of postoperative cerebrospinal fluid leakage after transsphenoidal pituitary tumor surgery.Methods The clinical data of 6 patients with cerebrospinal fluid leak in Department of Otolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2011 to June 2022. In 6 patients with postoperative cerebrospinal fluid leakage after transsphenoidal pituitary surgery, the bilateral posterior septal arteries were sacrificed due to the endoscopic transsphenoidal expanded approach, so the ethmoid artery pedicled septal floor mucosal flaps were adopted.Results All patients had good growth of the mucosal flaps during postoperative follow-up without recurrent cerebrospinal fluid leakage.Conclusion Cerebrospinal fluid leakage is still one of the postoperative complications of pituitary surgery. For patients with bilateral posterior septal arteries sacrificed through the transsphenoidal approach, when the classic posterior septal artery pedicled mucosal flap is not available, the ethmoid artery pedicled septal floor mucosal flap is one of the alternative methods.
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表 1 6例垂体瘤术后脑脊液漏患者的临床资料
例序 性别 年龄/岁 病情 垂体瘤手术史 放疗史 脑脊液漏修补史 修补材料 颅内感染 修补材料 随访时间/年 1 男 50 垂体瘤术后 23 d前 无 无 - 有 筛动脉瓣 8 2 女 64 垂体瘤术后 1个月前 无 无 - 有 筛动脉瓣 8 3 男 48 垂体瘤术后 4年前 无 无 - 有 筛动脉瓣 6 4 女 38 垂体瘤术后 5年前 无 8个月前 脂肪 有 筛动脉瓣 4 5 男 59 垂体瘤术后 6年前 无 无 - 有 筛动脉瓣 2 6 女 27 垂体瘤术后 1年前 无 无 - 有 筛动脉瓣 2 
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