内镜经鼻蝶入路切除累及鞍外垂体瘤的疗效分析  

Therapeutic effect of resection of extrasellar pituitary adenomas via the endoscopic endonasal transsphenoidal approach

作　　者：吴昆 宋业勋[1] 蔡韬[2] 陈江波[1] 谭国林[1] WU Kun;SONG Yexun;CAI Tao;CHEN Jiangbo;TAN Guolin(Department of Otolaryngology Head and Neck Surgery,Changsha, Hunan, 410013, China;Department of Neurosurgery, the Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China)

机构地区：[1]中南大学湘雅三医院耳鼻咽喉头颈外科,湖南长沙410013 [2]中南大学湘雅三医院神经外科,湖南长沙410013

出　　处：《中国耳鼻咽喉头颈外科》2019年第3期146-149,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：国家自然科学基金资助项目(81870708)

摘　　要：目的探讨内镜经鼻蝶入路切除累及鞍外的垂体肿瘤的疗效及并发症。方法回顾性分析2013年1月～2016年1月中南大学湘雅三医院耳鼻咽喉头颈外科收治的24例采用内镜经单鼻孔鼻蝶入路手术治疗的累及鞍外的垂体瘤患者临床资料,其中伴甲介型蝶窦的垂体腺瘤2例,蝶窦气化正常的垂体腺瘤22例。结果 24例患者中,肿瘤全切除18例(75%),次全切除5例(20.8%),短暂性尿崩症18例,永久性尿崩症3例,颅内感染1例,鼻-鼻窦炎2例,鼻出血2例。2例甲介型蝶窦垂体腺瘤达到全切除,无手术并发症。结论内镜经鼻蝶入路可以更好的辨认蝶鞍区解剖标志,是鞍区肿瘤累及鞍旁及鞍上时可行的手术入路,同时蝶窦气化不良不应被视为此手术入路的绝对禁忌证。OBJECTIVE To investigate the curative effect and complications of resection of pituitary adenomas via the single-nostril endoscopic endonasal transsphenoidal approach. METHODS Clinical data of 24 patients with extrasellar pituitary adenomas underwent surgery using the single-nostril endoscopic endonasal transsphenoidal approach, admitted to the Otolaryngology Department of the Third Xiangya Hospital of Central South University between January 2013 and January 2016, were analyzed retrospectively. There were 2 pituitary adenomas with conchiform sphenoid sinus and 22 pituitary adenomas with pneumatized sphenoid sinus. RESULTS Of the 24 patients, 18 underwent total tumor resection(75%), 5 subtotal resection(20.8%). Postoperative complications of Transient diabetes insipidus occur red in 18 cases, per manent diabetes insipidus in 3 cases, intracranial infection in 1 case, sinusitis in 2 cases, epistaxis in 2 cases. Pituitary adenoma in 2 patients with conchiform sphenoid sinus were resected completely, and no complications were found. CONCLUSION The endoscopic endonasal transsphenoidal approach can better identify the anatomical markers of the sellar region and is a feasible operative approach when the tumor involved the parasellar and suprasellar region. Meanwhile, poor gasification of sphenoid sinus should not be regarded as an absolute contraindication of this approach.

关 键 词：内窥镜检查 蝶鞍 垂体肿瘤 蝶窦 

分 类 号：R736.4[医药卫生—肿瘤]