经鼻蝶入路切除垂体大腺瘤术中磨除鞍结节的临床探讨  

The effect of removal of tuberculum sella bone on the total resection rate of pituitary macroadenomas in endoscopic endonasal transsphenoidal surgery

作　　者：肖爵贤 程祖珏[1] 祝新根[1] 吕世刚[1] 沈晓黎[1] 郭华[1] 罗海涛 陈鹏 Xiao Juexian;Cheng Zujue;Zhu Xin′gen;Lyu Shigang;Shen Xiaoli;Guo Hua;Luo Haitao;Chen Peng(Department of Neurosurgery , the Second Affiliated Hospital of Nanchang University, Narichang 330006, China)

机构地区：[1]南昌大学第二附属医院神经外科,江西330006

出　　处：《中华神经外科杂志》2019年第4期339-342,共4页Chinese Journal of Neurosurgery

基　　金：江西省教育厅科学技术研究项目(60159)。

摘　　要：目的探讨鞍结节骨质磨除对神经内镜经鼻蝶入路垂体大腺瘤全切除率的影响。方法回顾性分析2013年2月至2017年2月南昌大学第二附属医院神经外科采用神经内镜经鼻入路手术切除的65例垂体大腺瘤患者的临床资料,其中28例术中未磨除鞍结节骨质(未磨除组),37例术中磨除(磨除组)。术后对所有患者行临床随访,随访内容包括复查头颅/垂体MRI平扫+增强扫描,功能型垂体腺瘤患者复查激素水平。比较两组患者的肿瘤全切除率、临床症状缓解率及术后并发症发生率。结果65例患者手术均成功。两组患者的年龄、性别、临床表现、内分泌功能、肿瘤质地和Hardy分级间的差异均无统计学意义(均P>0.05)。磨除组的全切除率高于未磨除组[分别为78.4%(29/37)、50.0%(14/28),P<0.05],但磨除组的尿崩症发生率高于未磨除组[分别为73.0%(27/37)、46.4%(13/28),P=0.029]。未磨除组和磨除组间临床症状缓解率[分别为89.3%(25/28)、91.9%(34/37)]、脑脊液漏[(分别为7.1%(2/28)、8.1%(3/37)]及新发垂体功能低下发生率[分别为3.6%(1/28)、5.4%(2/37)]的差异均无统计学意义(均P>0.05)。所有患者随访3~24个月,平均(7.8±2.5)个月。43例肿瘤全切除者均未复发;22例未全切除者中,8例(磨除组3例,未磨除组5例)于术后0.5~1.0年再次行神经内镜经鼻蝶入路全切除肿瘤。所有患者垂体功能基本恢复正常。结论磨除鞍结节骨质可能是提高神经内镜经鼻蝶入路垂体大腺瘤全切除率的重要因素。To explore the effect of removing the bone of the tuberculum sella on the total resection rate of pituitary macroadenomas in endoscopic transsphenoidal surgery. Methods We retrospectively analyzed the clinical data of 65 patients with pituitary macroadenomas treated with endonasal transsphenoidal surgery at Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University from February 2013 to February 2017. In 28 cases, the tuberculum sella bone was not removed (non-removed group), and in 37 cases the tuberculum sella bone was removed (removal group). All patients were followed up postoperatively and underwent examinations including head/pituitary MRI scan and enhanced scan, hormone levels in patients with functional pituitary adenomas. The total resection rate, clinical symptom remission rate and postoperative complication rate were compared between the two groups. Results All the 65 patients were successfully operated.There was no statistical significance among the age, sex, clinical manifestation, tumor secreting-types, texture and Hardy grade of patients in the two groups(all P>0.05). The gross total resection rate in the removed group[78.4%(29/37)]was higher than that in the non-removed group[50.0%(14/28)](P<0.05). However, the incidence of diabetes insipidus was higher in the former group than in the latter group[73.0%(27/37), 46.4%(13/28), P=0.029]. The postoperative symptom remission rate, cerebrospinal fluid leakage, and new pituitary under-function, were different although, but there were no statistically significant differences.In the non-removed and the removed group, the postoperative symptom remission rate [89.3%(25/28)vs.91.9%(34/37)], cerebrospinal fluid leakage[7.1%(2/28)vs.8.1%(3/37)], and new pituitary dysfunction[3.6%(1/28)vs. 5.4%(2/37)] were not statistically significant(all P>0.05). All cases were followed up for 3 months to 2 years, average 7.8±2.5 months. No tumor recurrence case was found in 43 patients whose tumor were total resection.Among the 22 patients(whose tumors

关 键 词：自然腔道内镜手术 垂体肿瘤 经鼻蝶入路 鞍结节 骨质磨除 

分 类 号：R736.4[医药卫生—肿瘤]