全神经内镜下经鼻蝶入路手术治疗垂体腺瘤72例临床分析  

Analysis of full endoscopic transnasal-transphenoidal approach for pituitary adenomas： the summary of 72 patients

作　　者：郭英[1] 李文胜[1] 蔡梅钦[1] 王辉[1] 何海勇[1] 龚谨[1] 张保豫[1] 黄振超[1] 罗伦[1] 

机构地区：[1]中山大学附属第三医院神经外科垂体瘤诊治中心,广州510630

出　　处：《中华显微外科杂志》2012年第5期364-366,I0003,共4页Chinese Journal of Microsurgery

基　　金：广东省产学研结合项目（20118090400098）;广东省科技计划项目（20118031800074）

摘　　要：目的探讨和评价全神经内镜下经鼻蝶入路切除垂体瘤的手术技巧及临床应用价值。方法2009年1月至2012年3月。完成72例单纯神经内镜经鼻一蝶垂体瘤切除术，回顾性分析患者术前、术后症状及激素水平变化、影像学资料、手术资料、并发症、随访资料等。结果72例病例中非功能性腺瘤22例（30．6％），泌乳素腺瘤24例（33．3％），生长激素腺瘤7例（9．7％），促肾上腺皮质激素腺瘤5例（6．9％），促甲状腺激素腺瘤1例（1．4％），多分泌性腺瘤13例（18．1％）；肿瘤全切除56例（77．8％），次全切除13例（18．0％），部分切除3例（4．2％）；并发脑脊液漏5例，出现短暂性尿崩6例。术后随访3．24个月，大部分功能性腺瘤术后激素基本恢复正常水平，术后1例视力变差．其余患者症状亦基本恢复正常。结论全神经内镜经鼻蝶手术切除垂体腺瘤是一项安全、微创、有效的方法，具有全程直视下切除肿瘤的优点，但系统、专业的训练及相应的设备是必不可少的。Objective To investigate and evaluate the clinical value of full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas. Methods Seventy-two patients, who under- went full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas, were selected from the Medical Center of Pituitary Adenomas of our hospital from January 2009 to March 2012. To retrospec- tively investigate pre- and post-operation symptoms, hormone levels, images information, operation informa- tion, complications, following-up information and so on. Results Among the 72 consecutive patients, there were 22 nonfnnctioning adenomas, twenty-four prolactin secreting adenomas, seven somatotropin secreting ade- nomas, five adrenocorticotropic hormone secreting adenomas, one thyrotropin secreting adenomas, and 13 mul- ti-secreting adenomas. The tumor removal was total in 56（77.8%）, subtotal 13 （18.0%）, and partial 3 （4.2%）. Five cases had CSF leaks, and 6 diabetes insipidus. After 3-24 months of follow-up, the levels of increasing- hormone declined to normal levels in most patients. Conclusion Full endoscopic transnasal transphenoidal approaeh for the surgery of pituitary adenomas is a kind of technique which is safe, minimally invasive, having less complications and fast recovery. However, it is necessary for surgeons to accept systematic and specialized training, and own advanced equipments.

关 键 词：神经内镜 垂体腺瘤 经鼻蝶入路 

分 类 号：R736.4[医药卫生—肿瘤]