支持臂固定神经内镜下双鼻孔入路切除垂体腺瘤  

Neuroendoscopic microsurgical treatment of pituitary adenomas using bilateral endonasal approach with fixed arm

作　　者：汪璟[1] 鲁晓杰[1] 王清[1] 季卫阳[1] 吴学潮[1] 

机构地区：[1]南京医科大学附属无锡第二医院神经外科,214002

出　　处：《中华神经外科杂志》2017年第5期494-497,共4页Chinese Journal of Neurosurgery

基　　金：江苏省科技厅临床专项基金（BL2013006）;江苏省医学重点人才（RC2011152）;江苏省“六大人才高峰”高层次人才（WSW-063）;江苏省“333高层次人才培养工程”（BRA2015051）

摘　　要：目的探讨支持臂固定神经内镜下双鼻孔入路双手显微操作切除垂体腺瘤的有效性及安全性。方法回顾性分析2015年1月至2015年12月南京医科大学附属无锡第二医院神经外科采用支持臂固定神经内镜下双鼻孔经鼻蝶窦入路双手显微操作切除57例垂体腺瘤患者的临床资料，术中对“假包膜”的进行“假包膜外切除”，同时术中采用“潜水技术”提高肿瘤的全切率。结果57例垂体腺瘤中，肿瘤全切除48例（84％），近全切除7例（12％），部分切除2例（4％）。术后12h复查激素水平：28例（88％，28／32）催乳素水平恢复正常，8例（80％，8／10）生长激素、类胰岛素生长因子-1水平恢复正常。术后视力、视野改善30例（88％，30／34）。术后2周至2个月发生脑脊液漏3例，经神经内镜下鞍底修补及腰大池引流术治疗后均痊愈。无一例颅内感染及颈内动脉破裂出血等严重并发症发生。结论神经内镜支持臂辅助下双鼻孔入路双手显微操作切除垂体腺瘤，同时结合“假包膜外切除”及“潜水技术”，大大提高了垂体腺瘤的全切率，同时也提高了手术的安全性。Objective To explore the efficacy aud safety of the neuroendoscopic microsurgical treatment of pituitary adenomas using bilateral endonasal approach with fixed arm. Methods A total of 57 patients with pituitary adenomas underwent neuroendoscopic microsurgical operations using bilateral endonasal transsphenoid approach with fixed arm at Department of Neurosurgery, the 2nd Affiliated Hospital of Nanjing Medical University from January 2015 to December 2015. Their clinical data were retrospectively analyzed. Extracapsular resection was performed for lesions with pseudocapsules, and the diving technique was applied to improve the rate of gross total resection （GTR）. Results Among the 57 patients, GTR was achieved in 48（84%） cases, subtotal resection in 7 （12%） cases, and partial resection in 2 （4%）. The hormone levels were retested at 12 hours post operations, and the results revealed that the prolactin levels in 28 （88% ,28/32） cases and the levels of growth hormone and insulin-like growth factor 1 in 8 （80% ,8/10） cases recovered to normal. Postoperative improvement of vision and visual field occurred in 30 （88% ,30/34） cases. Three patients developed cerebrospinal fluid rhinorrhea 2 weeks to 2 months post operations, which resolved after endoscopic repair of saddle bottom and lumbar cistern drainage. No serious complications such as intracranial infection or rupture of internal carotid artery were observed. Conclusion Neuroendoscopic microsurgery using bilateral endonasal approach with fixed arm, combined with pseudocapsule-based extracapsular resection and the diving technology, could be performed to significantly increase the GTR rate of pituitary adenomas and improve the surgical safety.

关 键 词：垂体肿瘤 神经内镜 潜水技术 假包膜 治疗结果 

分 类 号：R736.4[医药卫生—肿瘤]