垂体瘤经鼻显微切除手术的 MSCT 评价  

MSCT evaluation of endonasal transphenoidal microsurgery for pituitary adenoma

作　　者：兰永树[1] 戴贵东[1] 肖正远[1] 熊义林[1] 

机构地区：[1]泸州医学院附属医院放射科,四川泸州646000

出　　处：《实用放射学杂志》2014年第6期904-907,929,共5页Journal of Practical Radiology

摘　　要：目的：探讨多层螺旋 CT（MSCT）对垂体瘤经鼻显微切除术前、术后评估的可行性及价值。方法采用64层 CT 对拟做经鼻显微切除手术的垂体瘤患者82例行头部 CTA 检查。扫描图像传至工作站进行 MIP、VR、MPR 重建,术前根据垂体瘤与其周围血管的关系进行分型。在 VR 图像上测量颈内动脉间的最短径、最长径及肿瘤的长、宽径,测量鼻外孔至蝶窦顶后壁及肿瘤顶后缘的长度,在冠状面图像上观察蝶窦的分隔情况。术后做 CT 复查观察大血管损伤、出血量及肿瘤残留情况,评价手术效果。结果A 型病例39例,B 型30例,C 型13例。颈内动脉间最短径1.2-2.0 cm、最长径1.8-3.2 cm,肿瘤长径1.7-3.9 cm、宽径1.3-2.5 cm；鼻外孔至蝶窦顶后壁及肿瘤顶后缘的长度分别是6.9-7.6 cm 和9-12.2 cm。蝶窦无分隔者15例,34例为一分隔,26例为双分隔,7例为三分隔以上。肿瘤相对颈内动脉间径线小的病例手术效果好。3种类型垂体瘤经鼻显微切除术评价具有统计学差异（P ＆lt;0.05）。结论 MSCT 能较好反映垂体瘤及其与周围结构的空间位置关系,是经鼻显微切除术前评估、术后评价的有效方法。Objective To explore the feasibility and value of MSCT for the evaluation of hypophysoma before and after endonasal transphenoidal microsurgery.Methods 82 patients with hypophysoma intended to be treated by endonasal transphenoidal microsurgery,were examined by 64-slice head CT angiography （CTA）.All the images were transmitted to workstation and reconstructed by MIP、VR and MPR.The hypophysoma were typed according to the relationship between hypophysoma and its surrounding vessels. The shortest and longest diameter between internal carotid arteries of two sides,tumor length and width,the diameter between external naris and the rear wall of sphenoid top and the length from external naris to the rear wall of tumor top were measured in VR images.Sphenoid division was observed in coronal plane image.Major vascular injury,bleeding,and residual tumor situation were observed on postoperative CT review.The surgery effect was evaluated by three associate professorwith SPSS 13.0.Results 39 cases were type-A,30 were type-B,13 were type-C,tumor length ranged from 1.7 cm to 3.9 cm,width ranged from 1.3 cm to 2.5 cm,the diameter between external naris and the rear wall of sphenoid top and the length between external naris and the rear wall of tumor top were 6.9 cm-7.6 cm and 9 cm-12.2 cm.There are 1 5 cases of sphenoid without division,34 cases with one division,26 cases with two division and at least three division in 7 cases.The surgery effect was better in those which tumor size was relatively smaller compared to the diameter of the internal carotid artery.The evaluation of endoscopic endonasal transsphenoidal surgery with three types of pituitary adenomas had a significant difference （P 〈0.05）.Conclusion MSCT can preferably reflect the spatial location relationship between pituitary adenimas and its surrounding structure,and it is effective evaluation methods for pre-operative and postoperative evaluation of transnasal microsurgical resection.

关 键 词：垂体瘤 微创手术 血管造影 计算机体层成像 

分 类 号：R739.41[医药卫生—肿瘤] R814.43[医药卫生—临床医学]