目的 探讨神经内镜经双侧鼻中隔黏膜下入路在垂体腺瘤外科治疗的手术疗效.方法 回顾性分析50例垂体瘤患者的临床资料,根据手术方式分为黏膜入路组(n=26)与经典入路组(n=24),并在围手术期观察指标(手术时间、术中出血量、术中脑脊液漏、术后住院时间)、肿瘤切除率、激素生化缓解率及术后并发症率上进行比较分析.结果 黏膜入路组与经典入路组,在手术时间/术中脑脊液漏/手术出血量指标上无明显差异,P值(0.089 7/0.385/1.000)均大于0.05;肿瘤切除效果上,两组全切率均为88％,两者无明显性差异(x2=0.110,P=0.917).黏膜入路组激素生化缓解率为83％,经典入路组为63％,两组之间无统计学差异(x2=1.847,P=0.174＞0.05).术后并发症上,两组在术后短暂性尿崩、颅内感染、垂体功能下降上无统计学差异,P分别为0.174/1.000/0.480/0.623,均大于0.05;术后住院时间及鼻部并发症的P值分别为0.001/0.022小于0.05,存在显著性差异.结论 与经典的内镜下双侧经鼻蝶入路垂体瘤切除术相比,神经内镜经双侧鼻中隔黏膜下入路在垂体瘤切除上能够更好地保护鼻腔解剖结构与功能,减少术后住院时间与鼻部并发症发生率,同时也是一个安全有效的手术方式.

Objective:To observe the effect of gaze stabilization exercises on the balance of stroke patients.Methods:Forty stroke patients were randomly divided into an experimental group ( n=20) and a control group ( n=20). Both groups were given conventional rehabilitation therapy, while the experimental group was additionally provided with gaze stabilization exercises, once a day, five days a week, for a total of four weeks. Each session lasted 30 minutes. Before and after the four weeks, both groups were evaluated in terms of their envelope ellipse area and the plantar pressure distribution on the affected side in static standing and using the anterior-posterior center of pressure displacement velocity (AP-COPV). They were also assessed using the Berg Balance Scale (BBS), the timed up-and-go test (TUGT), and the Activities-specific Balance Confidence Scale (ABC). Results:After the gaze stabilization exercises, the average envelope ellipse area, the plantar pressure distribution of the affected side with the eyes open and closed, AP-COPV, BBS score, TUGT time and ABC score of the experimental group were significantly superior to the control group′s averages and to the results four weeks previously.Conclusions:Gaze stabilization exercises can improve balance, weight shifting and one-leg standing after a stroke. That should enhance balance confidence and reduce the risk of falling.

ObjectivesThe endoscopic endonasal approach (EEA) is widely used in the treatment of cranial base tumors. Skull base reconstruction is a crucial part of EEA, which has a great impact on patients’ prognosis. In this study, we report our experience with sellar dural suturing in cranial base reconstruction and retrospectively analyze its effect.MethodsThe clinical data of 134 patients who suffered intraoperative CSF leakage and underwent EEA surgery in the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University from October 2018 to November 2020 were retrospectively collected and analyzed. According to whether sellar dural suturing was performed during the operation, they were divided into a suture group (55 cases) and a control group (79 cases).ResultsThe results showed that dural suturing of the sellar floor effectively reduced the postoperative hospitalization duration (p = 0.026) and the use rates of lumbar drainage (p = 0.047), autologous fat transplantation (p = 0.038), and pedicled nasoseptal flaps (p = 0.026).ConclusionSellar dural suturing under endoscopy is a promising and effective method for cranial base reconstruction in EEA surgery and is worthy of clinical application.

目的 探讨影响桥小脑角区(CPA)表皮样囊肿预后的相关危险因素,以指导改进桥小脑角区表皮样囊肿的治疗,改善预后.方法 回顾性分析23例桥小脑角区表皮样囊肿患者的临床资料.观察分析患者手术效果及术后恢复情况,根据患者的术后恢复及出院后的随访情况将其分为预后良好组(15例)和预后不良组(8例).比较两组患者的基本资料、手术方式及预后,并对相关因素进行单因素及多因素分析.结果 两组患者的年龄、是否为复发病例、肿瘤最大径、肿瘤是否越过中线、手术方式及术中出血量的差异具有统计学意义(P ＜0.05 ～0.01).其中肿瘤最大径和手术方式为影响预后的独立危险因素(均P＜0.05).而性别、病程、术前是否有颅神经损害、是否合并其他慢性病、切除程度及是否放置引流的差异则均无统计学意义(均P＞O.05).单纯显微镜与神经内镜辅助显微镜手术患者的术中出血量、术后颅神经损害、术后住院天数的差异有统计学意义(P ＜0.05～0.001),而肿瘤切除程度、术后发热、术前症状是否缓解的差异则无统计学意义(均P＞O.05).结论 除了降低年龄、病程、肿瘤体积等危险因素的影响外,手术方式的选择也是改善桥小脑角表皮样囊肿预后的关键因素.神经内镜辅助显微镜手术的应用能够减少术中损伤和术后并发症,提高病变切除程度,缩短患者手术后住院的时间.

Objective To summarize the experience of sellar dural suture technique in endoscopic transsphenoidal pituitary adenoma resection. Methods From October 2018 to November 2019, 25 patients with pituitary adenomas who underwent endoscopic transsphenoidal pituitary adenoma resection were selected. All of the 25 patients had cerebrospinal fluid (CSF) leakage during operation and underwent dural suture at the sellar floor. Results The total tumor resection rate was 100% (25/25). The dural suture time was 24 min in average, and the later 15 cases had an average time of 15 min. The successful rate of CSF leakage repair was 100% (25/25). There were no postoperative CSF leakage and lumbar cistern drainage. Two cases were repaired with nasal mucosal flap because of dural defect. No perioperative infection or other complications occurred. The average follow⁃up period was 9.62 months. One case of prolactinoma recurred and there was no delayed CSF leakage or death case. Conclusions Sellar dural suture is a safe and reliable technique to reduce the incidence of CSF leakage after pituitary adenoma surgery. It can reduce the application of autologous fat transplantation, autologous fascia transplantation and pedicled nasal septum mucosal flap, so as to reduce the occurrence of corresponding complications, which is worthy of clinical promotion. doi:10.3969/j.issn.1672⁃6731.2021.04.015