鞍区肿瘤经鼻蝶内镜下切除术后近期死亡原因及危险因素分析

张鑫; 王晓澍; 钱澳; 陈松; 霍钢

doi:10.16016/j.2097-0927.202110166

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鞍区肿瘤经鼻蝶内镜下切除术后近期死亡原因及危险因素分析

临床医学 | 更新时间：2026-01-09

- 鞍区肿瘤经鼻蝶内镜下切除术后近期死亡原因及危险因素分析
- Causes and risk factors of recent death for sellar tumors after endoscopic transsphenoidal surgery: analysis of 1 635 cases
- 陆军军医大学学报 2022年44卷第10期页码：1041-1047
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院神经外科
- 作者简介：
  
  [霍钢，E-mail: Xiaomin198171@tom.comHUO Gang, E-mail: Xiaomin198171@tom.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202110166
  中图分类号： R181.32;R739.41;R765.041
- 收稿：2021-10-27，
  
  修回：2022-01-14，
  
  纸质出版：2022-05-30
- 稿件说明：
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张鑫, 王晓澍, 钱澳, 等. 鞍区肿瘤经鼻蝶内镜下切除术后近期死亡原因及危险因素分析[J]. 陆军军医大学学报, 2022,44(10):1041-1047.

Xin ZHANG, Xiaoshu WANG, Ao QIAN, et al. Causes and risk factors of recent death for sellar tumors after endoscopic transsphenoidal surgery: analysis of 1 635 cases[J]. Journal of Army Medical University, 2022, 44(10): 1041-1047.
张鑫, 王晓澍, 钱澳, 等. 鞍区肿瘤经鼻蝶内镜下切除术后近期死亡原因及危险因素分析[J]. 陆军军医大学学报, 2022,44(10):1041-1047. DOI： 10.16016/j.2097-0927.202110166.

Xin ZHANG, Xiaoshu WANG, Ao QIAN, et al. Causes and risk factors of recent death for sellar tumors after endoscopic transsphenoidal surgery: analysis of 1 635 cases[J]. Journal of Army Medical University, 2022, 44(10): 1041-1047. DOI： 10.16016/j.2097-0927.202110166.

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1 635例，其中包括内镜下经鼻蝶入路(endoscopic transsphenoidal approach，ETA)1 470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%(9/1 635)。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

＜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。

Abstract

Objective

To investigate the causes and risk factors of recent death (within 30 d postoperatively) of patients with sellar tumors after endoscopic transsphenoidal surgery (ETS).

Methods

The 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.

Results

In the past 10 years

there were 1 635 cases of ETS surgery in our department

including 1 470 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% (9/1 635). The causes of death included: ① hemorrhage in the operative area in 3 cases (subarachnoid hemorrhage in 1 case and residual tumor hemorrhage in the operative area in 2 cases); ② infection in 3 cases (2 cases of meningitis and 1 case of blood-borne infection); ③ hypothalamus injury in 1 case; ④ vascular injury in 1 case; ⑤ epileptic 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

0.05). Multivariate logistic regression analysis indicated that intraoperative CSF leakage was the only independent risk factor.

Conclusion

The 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.

关键词

Keywords

references

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