导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤  

Neuronavigation-Guided Pure Endoscopic Endonasal Transsphenoidal Surgery for Complex Pituitary Adenomas

作　　者：薛亚军[1] 赵耀东[1] 崔大明[2] 沈照立[2] 楼美清[1] 

机构地区：[1]上海交通大学附属上海第一人民医院神经外科,上海200080 [2]同济大学附属第十人民医院神经外科,上海200072

出　　处：《中国临床医学》2015年第1期95-98,共4页Chinese Journal of Clinical Medicine

摘　　要：目的：分析导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤的疗效。方法：回顾分析2010年4月—2012年9月采用内镜下经鼻蝶手术治疗的60例复杂垂体腺瘤患者的疗效。患者具有下列一项或多项特征：肿瘤直径〉4 cm（34例）,Knosp分级3～4级（41例）,复发或残留腺瘤（17例）。所有患者采用内镜下经鼻蝶垂体腺瘤切除术,术中使用神经导航辅助。术后行视力、神经影像及内分泌学检查。结果：60例患者中,无功能腺瘤33例,功能性腺瘤27例;肿瘤行大体全切42例,大部切除11例,部分切除7例。术后视力改善32例,内分泌治愈8例。直径〉4 cm腺瘤大体全切18例,Knosp分级3～4级腺瘤大体全切23例,复发或残留腺瘤大体全切12例。术后发生电解质紊乱4例,脑脊液鼻漏3例,尿量增多1例,术区出血导致视力下降、垂体前叶功能低下、嗜睡1例,再手术5例。结论：导航辅助内镜下经鼻蝶手术治疗复杂垂体腺瘤安全、有效,对Knosp分级4级的侵袭性腺瘤、复杂功能性腺瘤的疗效仍有待进一步提高。Objective：To analyze the efficacy of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for the surgical removal of complex pituitary adenomas.Methods：The clinical data of 60 patients who received pure endoscopic endonasal transsphenoidal surgery for complex pituitary adenomas from Apr 2010 to Sep 2012 was retrospectively analyzed.These patients had one or more characteristics which including tumors more than4 cm in size（34 patients）,Knosp grade 3-4（41patients）,recurrent or residual tumor（17 patients）.All patients received pure endoscopic endonasal transsphenoidal surgery and neuronavigation was used.Neuro-ophthalmological,neuroimaging and endocrinological examination were performed postoperatively.Results：There were 33 nonfunctional adenomas and 27 functional adenomas.Overall,the tumors were gross totally removed in 42 patients,subtotal removed in 11 patients and partially removed in 7 patients.Postoperative visual acuity was improved in32 patients,endocrine remission was achieved in8 patients.The gross total removal was achieved in18,23 and12 patients for tumors more than 4 cm in size,Knosp grade 3-4 adenomas,recurrent or residual adenomas,respectively.The postoperative complications included electrolyte disturbances in4 patients,cerebral spinal fluid leakage in3 patients,insipidus in1 patient.And 1 patient had visual impairment,hypopituitarism and hypersomnia caused by postoperative hemorrhage.And 5patients had reoperation.Conclusions：Neuronavigation-guided pure endoscopic endonasal transsphenoidal surgery is safe and effective for complex pituitary adenoma.The effectiveness of that approach for invasive pituitary adenomas（Knosp grade 4）and complex functional adenomas still need to be promoted.

关 键 词：垂体巨腺瘤 侵袭性垂体瘤 复发垂体瘤 神经内镜 内镜经鼻蝶手术 神经导航 

分 类 号：R736.4[医药卫生—肿瘤]