内镜经鼻入路治疗垂体腺瘤138例  

Endoscopic endonasal pituitary adenomas surgery for 138 consecutive patients

作　　者：寿雪飞[1] 赵曜[1] 张晓硌[1] 沈明[1] 李士其[1] 王镛斐[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华神经外科杂志》2014年第10期984-988,共5页Chinese Journal of Neurosurgery

基　　金：基金项目：上海市级医院新兴前沿技术（SHDC12013121）

摘　　要：目的 探讨内镜经鼻入路治疗垂体腺瘤的手术技巧,分析肿瘤全切除和内分泌缓解的相关影响因素。方法 回顾性分析2011年3月至2013年8月138例内镜经鼻入路垂体腺瘤手术.经鼻入路包含常规经鼻-蝶窦入路和经鼻-筛窦入路（4例）、经鼻-上颌窦入路（1例）、经鼻-斜坡入路（1例）。结果 根据术后影像学和内分泌检查结果,全切除108例（78.3％）,功能型垂体腺瘤内分泌缓解31例（44％）。术后严重并发症有颅内感染（4例）和颅内出血（1例）.结论 肿瘤全切除率和内分泌缓解率,与肿瘤体积和是否侵袭海绵窦有关,影响侵袭性功能型垂体腺瘤内分泌缓解率的因素有肿瘤侵袭方向、侵袭程度及术者的手术经验。Objective To study the surgical techniques and analyze the related factors affecting the tumor total removal and postoperative endocrinological remission for endoscopic endonasal pituitary adenomas surgery.Methods The cases of endoscopic endonasal pituitary adenomas surgery from March 2011 to August 2013 were retrospectively analyze.The endonasal approaches included the routine transnasal-sphenoidal approach,transnasal-maxillary sinus approach in 4 cases and transnasal-clivus approach in one case.Results According to the postoperative imaging data and endocrine examination results,the total removal of tumors was achieved in 108 patients （78.3%）,and the endocrinological remission was achieved in 31 patients （44%） with functional adenomas.The serious postoperative complications included four cases of intracranial infection and one case of intracranial hemorrhage.Conclusions The tumor size and invasiveness of cavernous sinus were related to the total removal rate and endocrinological remission rate.The direction and degree of tumor invasion,and the surgeon＇s experience were the key influence factors of the endocrinological remission rate for invasive functional pituitary adenomas.

关 键 词：神经内镜 垂体腺瘤 经鼻入路 

分 类 号：R736.4[医药卫生—肿瘤]