神经内镜扩大经鼻入路切除侵袭性垂体腺瘤  

Extended endoscopic endonasal approach for resection of invasive pituitary adenomas

作　　者：阳吉虎 黄国栋[1] 纪涛[1] 王海东 郭见 黎震 郑文键 李维平[1] 

机构地区：[1]深圳大学第一附属医院神经外科,518035

出　　处：《中华神经外科杂志》2017年第10期1000-1004,共5页Chinese Journal of Neurosurgery

基　　金：广东省科技计划项目（2014A020212050,2017A020215089）;深圳神经外科重点实验室项目（ZDSYS20140509173142601）

摘　　要：目的 探讨神经内镜扩大经鼻入路切除侵袭性垂体腺瘤（IPA）的手术方式和临床疗效.方法 2014年5月至2016年9月深圳大学第一附属医院神经外科采用神经内镜扩大经鼻入路切除IPA患者49例（50例次手术）,其中经鼻海绵窦内入路29例次、海绵窦外入路9例次、鞍结节平台入路7例次、鞍膈切开和（或）鞍背切除入路5例次.回顾性分析不同Knosp分级、不同Hardy分期肿瘤的切除率、治愈率及并发症情况.结果 50例次手术中,肿瘤全切除34例次（68.0％）,次全切除10例次（20.0％）,部分切除6例次（12.0％）.生物学治愈28例（57.1％,28/49）.其中Knosp3级、4级垂体腺瘤全切除比例分别为10/11、4/16,生物学治愈比例分别为7/11、3/16;Hardy C、D、E期肿瘤全切除比例分别为9/10、10/12、6/19,生物学治愈比例分别为8/10、8/12、4/19.49例中,术后脑脊液鼻漏7例（14.3％）（其中3例合并颅内感染）,电解质紊乱16例（32.7％）,一过性尿崩23例（46.9％）,一过性垂体功能低下16例（32.7％）,永久性垂体功能低下2例（4.1％）,术后鼻出血1例（2.0％）.随访4 ～31个月,平均（16.0±8.3）个月,全切除患者随访期间未见复发,1例部分切除患者术后复发再次手术.结论 根据IPA的生长方式,选择适宜的神经内镜经鼻手术入路有助于切除肿瘤,减少并发症.Objective To explore the surgical method and clinical effect of endoscopic endonasal approach for the treatment of invasive pituitary adenomas （IPA）.Methods A retrospective analysis was conducted on the clinical data of 49 patients （50 procedures） with IPA treated through endoscopic endonasal approach at Department of Neurosurgery,the First Affiliated Hospital of Shenzhen University,from May 2014 to September 2017.Among them,the trans-cavernous approach was taken in 29 patients,the lateralcavernous approach in 9 patients,the tuberculum sella planum approach in 7 patients and the diaphragmasellae-cut and （or） dorsum-sellae-removal approach in 5 patients.The following aspects were investigated including extent of resection,curing rate and complications in patients with varying Knosp classifications and Hardy stages.Results Among all 50 procedures,gross total resection （GTR） was achieved in 34 cases （68.0%）.Subtotal resection was in 10 case（20.0%） and 6 cases（12.0%） of partial resection.Biology cured 28 cases（57.1%,28/49）.The GTR rate for pituitary adenoma was 10/11 for grade 3 and 4/16 for grade 4 based on Knosp classification.The GTR rate was 9/10 for Hardy stage C,10/12 for stage D and 6/19 for stage E.The rate of biology cure was 8/10 for stage C,8/12 for stage D and 4/19 for stage E.Postoperative complications included 7 （14.3%） cases of cerebrospinal fluid leaks,16 （32.7%） cases of electrolyte imbalance,23 （46.9%） cases of transient diabetes insipidus,16 （32.7%） cases of hypopituitarism,2 （4.1%） cases of permanent hypopituitarism,and 1 （2.0%） case of epistaxis.The followup lasted 4-31 months with an average of 16 months.None reported recurrence in the group of GTR.One undergoing subtotal resection reported recurrence and received a second operation.Three patients underwent postoperative Gamma knife radiosurgery.Two patients with refractory IPA were administered temozolomide and metformin chemotherapy.Conclusion Based on the invasiveness of IPA,proper choi

关 键 词：侵袭性垂体腺瘤 神经内镜 神经外科手术 入路 

分 类 号：R736.4[医药卫生—肿瘤]