摘要
目的探讨鞍区肿瘤患者行经鼻蝶内镜下切除术(endoscopic transsphenoidal surgery,ETS)后近期(术后30 d以内)死亡的原因及危险因素。方法回顾性分析2011年1月至2021年3月于我科行ETS的鞍区肿瘤患者的临床资料,统计死亡病例,分析死亡原因,并采用单因素分析和多因素Logistic回归分析确定术后死亡的独立危险因素。结果纳入行ETS的鞍区肿瘤患者共1635例,其中包括内镜下经鼻蝶入路(endoscopic transsphenoidal approach,ETA)1470例,内镜下扩大经鼻蝶入路(extend endoscopic transsphenoidal approach,EETA)165例。术后近期死亡9例,死亡率0.55%(9/1635)。死亡原因包括:①术区出血及血肿3例(蛛网膜下腔出血1例,残余肿瘤出血及术区血肿2例);②感染3例(颅内感染2例,血行感染1例);③下丘脑损伤1例;④血管损伤1例;⑤癫痫持续状态1例。单因素分析结果显示:肿瘤长径>3 cm、肿瘤质地坚韧、术中出血量多、术中脑脊液漏、术后顽固性脑脊液漏、肿瘤残余、EETA可能与术后患者死亡有关(均P<0.05)。多因素Logistic回归分析显示:术中脑脊液漏为ETS术后患者死亡的独立危险因素。结论鞍区肿瘤患者术区出血及血肿、颅内感染、血行感染为ETS术后近期死亡的主要原因。有术中脑脊液漏的患者更易发生死亡。
ObjectiveTo investigate the causes and risk factors of recent death(within 30 d postoperatively)of patients with sellar tumors after endoscopic transsphenoidal surgery(ETS).MethodsThe clinical data of the patients with sellar tumors after ETS in our department from January 2011 to March 2021 were collected and retrospectively analyzed.Death cases were collected.Univariate analysis and multivariate logistic regression analysis were used to determine the independent risk factors for postoperative death.ResultsIn the past 10 years,there were 1635 cases of ETS surgery in our department,including 1470 cases of endoscopic transsphenoidal approach(ETA),and 165 cases of extend endoscopic transsphenoidal approach(EETA).Nine patients died recently after operation,with a mortality of 0.55%(9/1635).The causes of death included:①hemorrhage in the operative area in 3 cases(subarachnoid hemorrhage in 1 case and residual tumor hemorrhage in the operative area in 2 cases);②infection in 3 cases(2 cases of meningitis and 1 case of blood-borne infection);③hypothalamus injury in 1 case;④vascular injury in 1 case;⑤epileptic status in 1 case.Univariate analysis showed that diameter>3 cm,tough consistency,large amount of intraoperative blood loss,intraoperative cerebrospinal fluid(CSF)leakage,persistent postoperative CSF leakage,remnant tumor,and treatment of EETA may be associated with postoperative death after ETS(all P<0.05).Multivariate logistic regression analysis indicated that intraoperative CSF leakage was the only independent risk factor.ConclusionThe main causes of recent death of insellar tumor patients after ETS are hemorrhage in surgical area,meningitis and blood-borne infection.Those with intraoperative CSF leakage are more likely to die.
作者
张鑫
王晓澍
钱澳
陈松
霍钢
ZHANG Xin;WANG Xiaoshu;QIAN Ao;CHEN Song;HUO Gang(Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第10期1041-1047,共7页
Journal of Army Medical University
关键词
鞍区肿瘤
经鼻蝶内镜下切除术
死亡原因
危险因素
sellar tumor
endoscopic transsphenoidal surgery
causes of death
risk factors
