大及巨大垂体腺瘤切除术后个体化骨性鞍底重建的临床应用  

Clinical application of individual osseous sellar reconstruction after resection of pituitary macroadenomas and giant adenomas

作　　者：鲁明 邓心情 毕中胜 贺小军 卢建侃 林德留 Lu Ming;Deng Xinqing;Bi Zhongsheng;He Xiaojun;Lu Jiankan;Lin Deliu(Department of Neurosurgery,Gongdong 999 Brain Hospital,Guangzhou,Guangdong 510510,China)

机构地区：[1]广东三九脑科医院神经外五科

出　　处：《中国微侵袭神经外科杂志》2018年第7期298-300,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨内镜下经鼻蝶入路大及巨大垂体腺瘤切除术后鞍底重建的有效方法。方法回顾性分析52例大及巨大垂体腺瘤病人的临床资料。均行内镜下经鼻蝶入路肿瘤切除术,7例采用常规多层修补法重建鞍底(非骨性重建组),45例在多层修补的基础上加用骨性材料支撑(骨性重建组)。结果非骨性重建组中,全切除4例,次全切除3例,全切率57.1%,术后尿崩2例,无术中脑脊液漏。骨性重建组中,全切除30例,次全切除5例,大部分切除7例,部分切除3例,全切率66.7%;加用2孔连接片修补39例,4孔连接片1例,8孔连接片1例,PEEK雪花片4例;出现术中脑脊液漏16例,术后尿崩25例。两组术中脑脊液漏比较差异有统计学意义(P<0.05)。随访3~20个月,两组均无永久性尿崩,无死亡病例,无术后脑脊液漏。结论骨性重建是内镜下经鼻蝶入路切除大及巨大垂体腺瘤术后鞍底重建的有效方法。Objective To explore the effective methods for sellar reconstruction of pituitary macroadenomas and giant adenomas after endoscopic transsphenoidal surgery. Methods Clinical data of 52 patients with pituitary macroadenoma or giant adenoma were analyzed retrospectively, who received surgery via endoscopic transsphenoidal approach. The sellar reconstruction with a common multilayer repair was performed on 7 patients as non-osseous reconstruction group, and osseous material supporting on the base of multilayer repair was performed on 45 patients as osseous reconstruction group. Results In the non-osseous reconstruction group, total resection was achieved in 4 patients, subtotal resection in 3 and the rate of total resection was 57.1%. The postoperative diabetes insipidus occurred in 2 patients and no intraoperative cerebrospinal fluid leakage occurred in the non-osseous reconstruction group. Total resection was achieved in 30 patients, subtotal resection in 5, major resection in 7, partial resection in 3 and the total resection rate was66.7% in the osseous reconstruction group. The 2-hole titanium connector repair was added in 39 patients, 4-hole titanium connector repair in 1, 8-hole titanium connector repair in 1 and PEEK snowflake repair in 4. Intraoperative cerebrospinal fluid leakage occurred in16 patients and postoperative diabetes insipidus in 25 in the osseous reconstruction group. The difference in intraoperative cerebrospinal fluid leakage between the two groups was statistically significant（P〈0.05）. All the patients were followed up for 3 to 20 months, and no permanent diabetes insipidus, death, postoperative cerebrospinal fluid leakage occurred in both groups. Conclusion Osseous reconstruction is an effective method for repairing the sellar after endoscopic transsphenoidal surgery for pituitary macroadenomas and giant adenomas.

关 键 词：垂体肿瘤 神经内镜 入路 经鼻蝶 鞍底修复 骨性重建 

分 类 号：R739.41[医药卫生—肿瘤] R651.1[医药卫生—临床医学]