神经导航联合神经内镜扩大经蝶入路切除鞍区肿瘤的临床应用研究  

Clinical Application of Neuronavigation Combined with Neuroendoscopy in Extended Transsphenoidal Approach for Sellar Region Tumors

作　　者：叶新运[1] 赖文焘 宋海民[1] 吴至武 冯开明[1] 蒋秋华[1] YE Xinyun;LAI Wentao;SONG Haimin;WU Zhiwu;FENG Kaiming;JIANG Qiuhua(Ganzhou People’s Hospital,Ganzhou 341000,China)

机构地区：[1]江西省赣州市人民医院,江西赣州341000

出　　处：《中国医学创新》2020年第4期146-150,共5页Medical Innovation of China

基　　金：赣州市科技局指导性科技计划项目(GZ2017ZSF214);赣州市卫计委计划项目(2017-2-5)。

摘　　要：目的:探讨鞍区肿瘤患者神经导航联合神经内镜扩大经蝶入路切除术方式的临床应用价值。方法:选取赣州市人民医院神经外科于2014年1月-2017年12月收治的应用神经导航与神经内镜技术治疗的鞍区肿瘤患者76例,分析手术结果、术后并发症、手术及预后情况,综合评价该疗法的应用价值。结果:76例患者中70例肿瘤全切,5例次全切,1例部分切除,全切率92.11%。随访3个月~1年,患者的各种临床表现均有明显改善,随访期间1例部分切除患者于术后9个月复发,其他患者均未复发。术后,5例发生脑脊液鼻漏,1例形成颈内动脉海绵窦段假性动脉瘤,4例有嗅觉减退表现,4例有鼻塞表现,3例出现一过性多尿,2例出现电解质紊乱,均予以对症处理,未对手术效果造成严重不良影响。所有患者的平均手术时间为(193.26±58.62)min,平均住院时间为(10.35±1.02)d,平均住院费用(4.85±0.48)万元,末次随访KPS平均评分为(85.63±9.06)分。结论:以神经导航联合神经内镜扩大经蝶入路切除鞍区肿瘤,肿瘤全切率高,手术并发症少,手术时间及住院时间短,治疗费用低,整体预后状况良好,具有良好的应用前景。Objective:To explore the clinical value of neuronavigation combined with neuroendoscopy in the treatment of sellar region tumors by extended transsphenoidal approach.Method:Seventy-six patients with sellar tumors treated by neuronavigation and neuroendoscopy from January 2014 to December 2017 in the Department of Neurosurgery of Ganzhou People’s Hospital were selected.The surgical results,complications,operation and prognosis were analyzed,and the application value of the therapy was evaluated comprehensively.Result:Among 76 patients,70 cases had total resection of tumors,5 cases had subtotal resection and 1 case had partial resection.The total resection rate was 92.11%.All the clinical manifestations of the patients were significantly improved after 3 months to 1 year of follow-up.During the follow-up period,one patient with partial resection relapsed 9 months after operation,and none of the other patients relapsed.After operation,cerebrospinal fluid rhinorrhea occurred in5 cases,pseudoaneurysm in cavernous sinus segment of internal carotid artery in 1 case,hypoolusia in 4 cases,nasal obstruction in 4 cases,transient polyuria in 3 cases and electrolyte disturbance in 2 cases,all of which were treated symptomatically without serious adverse effect on the surgical results.The average operation time was (193.26±58.62) min,the average hospitalization time was (10.35±1.02) d,the average hospitalization cost was (4.85±0.48) million yuan,and the average KPS score at the last follow-up was (85.63±9.06) score.Conclusion:Neuronavigation combined with neuroendoscopy enlarged transsphenoidal approach for sellar region tumors has high total resection rate,fewer complications,short operation time and hospitalization time,low treatment cost,good overall prognosis and good application prospects.

关 键 词：神经导航 神经内镜 鞍区肿瘤 扩大经鼻蝶入路 

分 类 号：R739.41[医药卫生—肿瘤]