神经内镜下经鼻蝶入路垂体腺瘤手术切除的临床疗效分析

摘要

目的：探讨神经内镜下经鼻蝶入路垂体腺瘤手术切除的临床治疗效果。方法回顾分析上海交通大学医学院附属苏州九龙医院神经外科2011年7月～2013年8月收治的神经内镜下经鼻蝶入路垂体腺瘤手术切除的98例患者，其病理结果均为垂体腺瘤。手术前后分别行内分泌学检查，术后随访3个月，复查垂体MRI。结果肿瘤全切除率78．6％（77例），次全切除率16．3％（16例），部分切除率5．1％（5例）。术后视力、视野较术前明显改善者18例，激素水平较术前下降或完全恢复至正常者35例；发生脑脊液漏6例，其中4例经腰大池置管后治愈，另外2例行脑脊液鼻漏修补手术治愈，暂时性尿崩5例，高热及电解质紊乱2例，无死亡病例。术后平均住院时间5．5 d。结论神经内镜下经鼻蝶入路切除垂体腺瘤是一种安全、微创、有效的治疗方式，术后并发症少，减轻患者痛苦，缩短患者的住院时间。%Objective To analyze the clinical effects of endoscopic transsphenoidal pituitary adenoma resection .Methods The clinical data of 98 patients who were operated transsphenoidal by endoscopy in our department from July 2011 to August 2013 , were analyzed retrospectively and the pathology results were pituitary adenoma .Endocrinology examination were performed before and after surgery, patients were followed up to review the pituitary MRI three months after operation .Results The rate of tumor resection was 78.6%(77 cases),and subtotal resection rate was 16.3%(16 cases),partial resection rate was 5.1%(5 cases ).Visual acuity,field of vision before surgery significantly improved in 18 cases, compared with the preoperative hormone levels decrease or completely restored to normal in 35 , 6 cerebrospinal fluid leakage , including 4 after lumbar catheter cure , another 2 cerebrospinal fluid rhinorrhea repair surgery cured , 5 transient diabetes insipidus , 2 fever and electrolyte imbalance but no death .The mean postoperative hospital stay was 5.5 days. Conclusion Endoscopic transsphenoidal pituitary adenoma resection is safe , minimally invasive and effective , postoperative complications is low , and it can relieve pain and shorten hospital stay .