神经内镜经鼻入路治疗异形生长侵袭性垂体腺瘤的临床分析  

Clinical analysis of neuroendoscopic transnasal approach in the treatment of heteromorphic invasive pituitary adenoma

作　　者：李储忠[1] 桂松柏[2] 耿素民[2] 王新生[2] 赵澎[2] 白吉伟[2] 曹磊[2] 刘春晖[2] 朱海波[2] 李振业[2] 张亚卓[1] Li Chuzhong;Gui Songbai;Geng Sumin;Wang Xinsheng;Zhao Peng;Bai Jiwei;Cao Lei;Liu Chunhui;Zhu Haibo;Li Zhenye;Zhang Yazhuo(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,100070 [2]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经外科杂志》2022年第1期5-11,共7页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82072804);首都临床诊疗技术研究及示范应用项目(Z191100006619087)。

摘　　要：目的探讨异形生长的侵袭性垂体腺瘤神经内镜经鼻手术入路的选择及临床疗效。方法回顾性分析2019年4月至2020年5月首都医科大学附属北京天坛医院神经外科采用神经内镜经鼻入路治疗的117例异形生长的侵袭性垂体腺瘤患者的临床资料。其中肿瘤向鞍上侵袭105例,向侧方侵及海绵窦并包绕颈内动脉80例,向蝶鞍后方侵及脑干19例,向蝶鞍下方侵袭89例。根据垂体腺瘤异形生长的特点分别采用神经内镜经鼻蝶窦-鞍结节-蝶骨平台入路(35例)、神经内镜经筛窦-翼突-蝶窦-海绵窦入路(32例)、神经内镜经鼻蝶窦-斜坡入路(5例)、神经内镜经鼻多通道入路(45例)。术后随访内容包括临床症状、体格检查、头颅MRI及内分泌检验。结果117例患者中,肿瘤全切除67例,次全切除36例,大部分切除14例。无手术相关死亡病例,术后头痛、头晕的缓解率为67.6%(25/37),视力、视野的改善率为66.7%(52/78)。117例患者的中位随访时间为13个月(3~24个月),其中肿瘤复发2例,术后长期垂体功能低下5例,失嗅12例。结论对于异形生长的侵袭性垂体腺瘤,根据肿瘤的生长特点选择不同的神经内镜经鼻入路手术,可减少创伤,提高肿瘤的切除率,临床效果良好。Objective To evaluate the choice of surgical approach and clinical efficacy of neuroendoscopic transnasal approach in the treatment of heteromorphic invasive pituitary adenomas.Methods A retrospective analysis was conducted on the clinical data of 117 patients with heteromorphic pituitary adenoma treated with neuroendoscopic surgery in the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from April 2019 to May 2020.Among them,105 cases invaded the suprasellar area,80 cases invaded the cavernous sinus laterally and surrounded the internal carotid artery,19 cases invaded the brain stem behind the sella,and 89 cases invaded the area below the sella.According to the characteristics of the heteromorphic growth of pituitary adenomas,neuroendoscopic endonasal transsphenoid-tuberculum/planum approach was used in 35 cases,transethmoid-pterygoid-sphenoid-cavernous sinus approach in 32 cases,transsphenoid-clivus approach in 5 cases and endonasal multi-corridors approach in 45 cases.The postoperative follow-up content included clinical symptoms,physical examination,head MRI and endocrine examination.Results Among the 117 patients,total resection was achieved in 67 cases,subtotal resection in 36 cases,and major resection in 14 cases.There were no deaths related to surgery.After operation,the relief rate of headache and dizziness was 67.6%(25/37),and the improvement rate of vision and visual field was 66.7%(52/78).The median follow-up time of 117 patients was 13 months(3-24 months).There were 2 cases of tumor recurrence,5 cases of postoperative long-term hypopituitarism,and 12 cases of anosmia.Conclusions For invasive pituitary adenomas with heteromorphic growth,various endoscopic transnasal approaches and surgical methods could be chosen according to the growth characteristics of the tumor,which can reduce invasiveness,increase the tumor resection rate and be associated with good clinical efficacy.

关 键 词：垂体肿瘤 肿瘤侵润 自然腔道内镜手术 经鼻入路 异形生长 

分 类 号：R736.4[医药卫生—肿瘤]