经鼻蝶入路切除垂体腺瘤并发症分析与防治  

Analysis of complications in endonasal transsphenoidal surgery for pituitary adenomas and their prevention and treatment

作　　者：杨忠平 石斌[2] 仝海波 陈来照 高海平[2] 王景云[2] 靳涛[2] 

机构地区：[1]山西大医院神经外科,太原030032 [2]太原市中心医院神经外科

出　　处：《山西医科大学学报》2015年第7期683-686,共4页Journal of Shanxi Medical University

摘　　要：目的 分析经鼻蝶入路切除垂体腺瘤主要并发症发生原因并探讨其防治措施。方法 回顾性分析太原市中心医院神经外科2011-01～2014-08经鼻蝶入路切除垂体腺瘤35例患者病历资料,并结合文献分析各类并发症发生率及防治措施。结果 肿瘤全切除28例,次全切除5例,部分切除2例,无手术死亡病例。术后脑脊液鼻漏3例次,尿崩症8例次,电解质紊乱9例次,垂体功能低下5例次,鞍内血肿2例次,视力障碍恶化2例次,颅内感染1例次,外展神经麻痹1例次,1例患者术前合并动眼神经和外展神经麻痹,术后神经麻痹未恢复。结论 经鼻蝶入路切除垂体腺瘤是一种安全、微创、有效的治疗方法,但仍有多种并发症可能发生,熟悉局部显微解剖结构,术前做好评估,术中精细操作,积极预防并发症,可以进一步提高垂体腺瘤的手术治疗效果。Objective To explore the prevention and treatment of the complications in endonasal transsphenoidal surgery for pituitary adenomas. Methods Clinical data of 35 patients undergoing endonasal transsphenoidal surgery for pituitary adenomas from January 2011 to August 2014 were analyzed retrospectively, and the complications were observed. The literatures were reviewed to make measures for prevention. Results The tumor was totally removed in 28 cases, subtotally in 5 cases, and partially in 2 cases. The cerebral spinal fluid（CSF） rhinorrhea was found in 3 cases, diabetes insipidus in 8 eases, electrolyte disturbance in 9 cases, pituitary hypofunetion in 5 cases, intrasellar hemorrhage in 2 cases, visual deterioration in 2 cases, meningitis in 1 case, abducent nerve palsy in 1 case, and oculomoter and abducent nerve palsy were persistent before and after operation in 1 case. Conclusion Endonasal transsphenoidal surgery for pituitary adenomas is a safe, effective and minimal invasion method in treatment of pituitary adenomas, nev- ertheless, the complications should be aware of. The familiarity with the regional anatomy, overall preoperative evaluation, careful op- eration and prevention of complications are very important to improve further the therapeutic efficacy for pituitary adenomas.

关 键 词：垂体腺瘤 经鼻蝶入路 并发症 

分 类 号：R739.4[医药卫生—肿瘤]