显微镜下经单鼻孔-蝶窦入路切除垂体腺瘤的手术治疗效果  

Surgical Treatment Results and Treatment Experience of Resecting Pituitary Adenoma by Single nostril-sphenoid Sinus Approach under Microscope

作　　者：郭斌 李尧 李经辉[2] 耿鑫[2] 邹杨鸿 王志刚 徐耀端 余化霖[2] GUO Bin;LI Yao;LI Jing-hui;GENG Xin;ZOU Yang-hong;WANG Zhi-Gang;XU Yao-duan;YU Hua-lin(Dept.of Neurosurgery,The 5th Affiliated Hospital of Kunming Medical University,Gejiu Yunnan 661000;Dept.of Neurosurgery,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;Dept.of Neurosurgery,The 3rd People’s Hospital of Honghe Prefecture,Gejiu Yunnan 661000,China)

机构地区：[1]昆明医科大学第五附属医院神经外科,云南个旧661000 [2]昆明医科大学第一附属医院微创神经外科,云南昆明650032 [3]红河州第三人民医院神经外科,云南个旧661000

出　　处：《昆明医科大学学报》2019年第11期83-86,共4页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2017FE467,2015FA004)

摘　　要：目的探讨显微镜下经单鼻孔-蝶窦入路切除垂体腺瘤的手术治疗效果及治疗体会。方法回顾性分析采用显微镜下经单鼻孔-蝶窦入路切除的65例垂体腺瘤瘤患者的临床资料,其中泌乳素腺瘤21例,促肾上腺皮质激素腺瘤8例,促甲状腺素腺瘤8例,生长激素腺瘤12例,混合性垂体腺瘤9例,无功能腺瘤7例,对58例激素分泌性垂体腺瘤术前与术后1 a激素水平改变进行t检验。结果所有65例病例手术均顺利完成,垂体腺瘤均全切,无死亡病例。术后6月、1 a均规律随访。术后垂体激素41例完全恢复正常,14例明显好转,10例无明显变化,58例激素分泌性垂体腺瘤术后1 a激素水平较术前明显下降,差异有统计学意义(P<0.05)。视力下降、视野改变患者均有不同程度好转。术后脑脊液鼻漏5例,其中1例发生颅内感染,垂体功能低下4例,尿崩6例,给予相关治疗后均痊愈,术后6月、1 a随访复查鞍区MRI+增强均未见垂体腺瘤复发。结论显微镜下经单鼻孔-蝶窦入路切除垂体腺瘤为微侵袭性手术,具有创伤小、效果好、入路方便、安全性高等特点,体现微创神经外科技术的治疗理念,值得广泛应用于临床。Objective The study aimed to discuss the surgical treatment result and treatment experience of pituitary adenoma by single nostril-sphenoid sinus approach under microscope.Me thods Retrospective analysis was performed on the clinical data of 65 patients with pituitary adenoma resected by single nostril-sphenoid sinus approach under the microscope,including 21 cases of prolactin adenoma,8 cases of adrenocorticotropic adenoma,8 cases of thyrotropin adenoma,12 cases of growth hormone adenoma,9 cases of mixed pituitary adenoma and 7 cases of non-functional adenoma.T test was performed on the changes of hormone levels in 58 cases of hormone-secreted pituitary adenoma before and one year after surgery.P<0.05 was considered as the statistical difference,which was statistically significant.Re s ults All the 65 cases were successfully operated,and all pituitary adenomas were completely resected without death.The patients were followed up regularly 6 months and 1 year after surgery.Postoperative pituitary hormones returned to normal in 41 cases,improved in 14 cases,and no significant changes in 10 cases.The hormone level of 58 patients with hormone-secreted pituitary adenoma decreased significantly one year after surgery compared with that before surgery.The cases of visual acuity decreased and the visual field changed improved differently.Postoperative cerebrospinal fluid rhinorrhea was found in 5 cases,including 1 case of intracranial infection,4 cases of hypopituitarism and 6 cases of diabetes insipidus.All cases recovered after relevant treatment.No recurrence of pituitary adenoma was found in the reexamination of MRI+enhancement in the sellar region 6 months and 1 year after surgery.Conclus ion Resecting pituitary adenoma by single nostril-sphenoid sinus approach under microscope is a minimally invasive surgery with the advantages of small trauma,good effects,convenient access and high safety.It reflects the treatment concept of minimally invasive neurosurgery technology and is worthy of wide application in the clinic

关 键 词：显微镜 单鼻孔-蝶窦入路切除 垂体腺瘤 

分 类 号：R736.4[医药卫生—肿瘤]