Analysis of risk factors for intracranial infection after endoscopic transnasal pituitary adenoma resection and strategies for reconstructing skull base defects
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摘要:
目的 探讨内镜经鼻入路术后颅内感染发生的危险因素，选择最佳颅底修补策略。 方法 回顾性分析2016年12月至2019年12月山西医科大学第一医院收治的162例垂体瘤患者的临床资料。分析患者术后颅内感染发生率，并根据是否发生颅内感染将其分为感染组与非感染组，分析术后颅内感染发生的独立危险因素。 结果 162例患者中，颅内感染组11例（6.79%），非感染组151例（93.21%）。单因素分析表明，感染组术中体质量指数（boby mass index，BMI）、术中脑脊液漏、术后脑脊液漏及Kelly分级均高于非感染组，差异均具有统计学意义（均P < 0.05）。Logistic回归性分析表明，感染组BMI、术中脑脊液漏、术后脑脊液漏及Kelly分级是垂体瘤术后颅内感染的独立危险因素（均P < 0.05）。 结论 内镜经鼻入路垂体瘤切除术后颅内感染的发生与术中、术后脑脊液漏、Kelly分级相关，可根据Kelly分级制定合理的颅底修补策略。 Abstract:Objective To investigate the risk factors for the occurrence of intracranial infection (ICI) after endoscopic transnasal resection of a pituitary adenoma and to select the best strategy for reconstructing skull base defects. Method The clinical data of 162 patients with pituitary adenoma admitted into First Hospital of Shanxi Medical University between December 2016 and December 2019 were analyzed retrospectively. The incidence rate of ICI after surgery was analyzed. According to the occurrence of ICI, patients were stratified into ICI and non-ICI groups. The infected and non-infected groups of clinical data were collected and the independent risk factors for ICI after surgery were analyzed. Result Among the 162 patients, 11 patients (6.79%) developed ICI, whereas 151 patients (93.21%) did not develop ICI. Body mass index (BMI), intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were significantly higher in the ICI group than in the non-ICI group (P < 0.05). Logistic regression analysis showed that BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were independent risk factors for ICI after surgery (P < 0.05). Conclusions The incidence of ICI after endoscopic endonasal surgery is related to BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades. Furthermore, reasonable strategies for skull-base reconstruction should be developed according to the Kelly grading system. -
图 1 影响经鼻内镜垂体瘤切除术患者并发颅内感染的随机森林算法
A：基于随机森林算法得到各指标的重要性排序（采用平均下降Gini指数衡量）；B：在随机森林算法中，采用平均下降Gini指数，循环100次后得到的重要性排序（whisker：min to max）
表 1 Kelly脑脊液分级标准
表 2 162例垂体瘤患者临床资料
表 3 影响经鼻内镜垂体瘤切除术患者并发颅内感染的单因素分析
表 4 影响经鼻内镜垂体瘤切除术患者并发颅内感染的Logistic分析
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