神经内镜下经鼻蝶窦入路垂体ACTH腺瘤切除术47例临床分析  

Clinical research of endoscopic transphenoidal surgery for pituitary adrenocorticotropic hormone adenoma

作　　者：马翔宇[1] 张鑫[1] 李卫国[1] 张文华[1] 王新宇[1] 董明[2] 徐淑军[1] 李新钢[1] 

机构地区：[1]山东大学齐鲁医院神经外科,山东大学脑科学研究所,济南250012 [2]山东大学齐鲁医院内分泌科,济南250012

出　　处：《中华神经外科杂志》2014年第10期1012-1015,共4页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金

摘　　要：目的 初步探讨神经内镜下经鼻蝶窦入路垂体ACTH腺瘤切除术的手术技巧及并发症的预防.方法 根据患者临床症状、地塞米松抑制试验、岩下窦采血、神经影像学等检查筛选出47例垂体ACTH腺瘤患者,对以上患者全部行单鼻孔经鼻蝶窦入路肿瘤切除术.结果 肿瘤全切43例（91.5％）,部分切除4例（8.5％）.术后内分泌功能改善者44例（93.6％）,未改善者3例（6.4％）.术后出现并发症者6例（12.8％）,其中垂体功能低下者3例,脑脊液鼻漏者2例,脑干梗死者1例.术后随访4～52个月,出现并发症者有3例明显改善,4例未全切者经影像学证实无复发.结论 ACTH腺瘤患者高血压、糖尿病等内科合并症多,微腺瘤比例高,解剖结构辨认难度大,且部分患者需行瘤周垂体部分切除术,术中鞍膈及蛛网膜破裂的可能性大,围手术期风险较高.神经内镜下经鼻蝶窦入路术野清晰,可在直视下切除病变、重建鞍底,可安全有效切除垂体ACTH腺瘤.Objective To explore the surgical techniques and prevention of complications of endoscopic transphenoidal surgery （ETS） for pituitary adrenocorticotropic hormone （ACTH） adenoma.Methods Forty-seven patients with pituitary ACTH adenoma were selected in our department from examinations like high dose dexamethasone suppression test,bilateral inferior petrosal sinus sampling （BIPSS）,neuroimaging examination and so on.Then ETS via single nostril was carried out in these patients.Results Total resection was achieved in 43 （91.5%） cases and partial in 4 （8.5%）.After surgery,the endocrinal function was improved in 44 （93.6%） patients while 3 （16.4%） showed no obvious amelioration.The postoperative complications occurred in 6 patients （12.8%）,including 3 cases of hypopituitarism,2 cerebrospinal fluid rhinorrhea,1 case of brain stem infarction.After the follow-up of 4-52 months,the complications were obviously improved in 3 patients.4 patients without total resection demonstrated no recurrence by enhanced pituitary MRI.Conclusions Patients with ACTH adenoma tended to have more internal medical complications like hypertension,diabetes,and so on.And the higher proportion of micro-adenoma in these patients made the identification of anatomical structures difficult.Besides,as some patients needed partial hypophysectomy,they might have a higher possibility of diaphragma sellae and arachnoid membrane rupture.On the whole,the risks during perioperative period for ACTH adenoma was greater than those of other kinds of adenomas.While ETS had a bright surgical field,and could make direct resection of the lesion and sellar floor reconstruction possible.As a result,ETS was a safe and effective method for the surgical treatment of pituitary ACTH adenoma.

关 键 词：垂体ACTH腺瘤 库欣病 神经内镜 经鼻蝶窦入路 

分 类 号：R736.4[医药卫生—肿瘤]