经单侧鼻孔蝶窦入路显微手术切除大及巨大无功能垂体腺瘤疗效分析(附66例报告)  

Clinical Analysis of Endoscopic Single Nostril Transsphenoidal Resection of Nonfunctional Macroadenomas and Giant Adenomas(66 Cases Report)

作　　者：黎海滨[1] 张鹏[1] 王水娇[1] 岑庆君[1] LI Hai-bin;ZHANG Peng;WANG Shui-jiao;CEN Qing-jun(Department of Neurosurgery,the First People's Hospital of Zhaoqing,Zhaoqing 526000,Guangdong,China)

机构地区：[1]肇庆市第一人民医院神经外科

出　　处：《中国现代手术学杂志》2019年第6期445-448,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的回顾性分析66例经单侧鼻孔蝶窦入路显微镜下切除大及巨大无功能垂体腺瘤的效果。方法回顾性分析2014年1月至2018年12月在我科住院并进行经单鼻孔蝶窦入路显微手术的66例大及巨大无功能垂体腺瘤患者,讨论其症状改善情况、垂体瘤切除率、并发症、与肿瘤大小的关系。结果66例患者中头痛缓解率达到91.18%(31/34),视力视野障碍改善率83.33%(20/24),垂体功能紊乱改善率50%(4/8)。在66例患者中,肿瘤全切率为71.21%(47/66),Knosp0-2级的患者中全切率为90.48%(38/42),Knosp3-4级的患者中全切率仅有37.5%(9/24),Knosp4级残留率高达78.57%(11/14)。结论在显微镜下经单侧鼻孔蝶窦入路切除大及巨大无功能垂体腺瘤效果理想,并发症少,症状改善率高,安全有效。Knosp0-2级的大及巨大无功能垂体腺瘤全切率高,切除Knosp3-4级的大及巨大无功能垂体腺瘤全切率偏低,但能改善患者的临床症状。Objective To analyze the effects of endoscopic single nostril transsphenoidal resection of nonfunctional macroadenomas and giant adenomas.Methods A retrospective analysis was carried out in 66 patients with nonfunctional macroadenomas and giant adenomas who underwent endoscopic single nostril transsphenoidal resection in our department from January 2014 to December 2018.Relationships between the resection rate and the Knosp stage or the symptom improvement rate were studied as well.Results The headache relief rate of the 66 patients was 91.18%(31/34).The visual field improvement rate was 80.33%(20/24).And the pituitary dysfunction improvement rate was 50%(4/8).In 66 patients,the total tumor resection rate was 71.21%(47/66),with 90.48%(38/42)in Knosp0-2 patients and 37.5%(9/24)in Knosp3-4 patients.The residual rate in Knosp4 was 78.57%(11/14).Conclusion Under the microscope,the removal of large or giant nonfunctional pituitary adenomas through the single nostril and sphenoid sinus approach is ideal,safe,and effective,with fewer complications and higher symptom improvement rate.In Knosp0-2,the total removal rate is high.But in Knosp3-4,it shows a relative lower total removal rate,but it can improve the clinical symptoms of these patients.

关 键 词：垂体腺瘤 显微手术 蝶窦入路 

分 类 号：R651.1[医药卫生—外科学]