儿童垂体腺瘤的单中心手术治疗经验  

Experiences of treatment for pediatric pituitary adenoma at a single center

作　　者：王传伟[1] 戚其超 刘磊[1] 王延召 常成岳 倪石磊[1] 宫杰[1] Wang Chuanwei;Qi Qichao;Liu Lei;Wang Yanzhao;Chang Chengyue;Ni Shilei;Gong Jie(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Neurosurgery,Weifang People's Hospital,Weifang 261000,China)

机构地区：[1]山东大学齐鲁医院神经外科,济南250012 [2]潍坊市人民医院神经外科,潍坊261000

出　　处：《中华小儿外科杂志》2024年第10期884-890,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童垂体腺瘤的特点,总结手术治疗儿童垂体腺瘤的经验。方法回顾性分析2013年11月至2021年11月在山东大学齐鲁医院神经外科接受手术治疗的20例最终经病理证实为垂体腺瘤患儿的临床资料,其中男10例,女10例;患儿中位年龄为15岁,范围在11~17岁;20例患儿中无功能型腺瘤4例,泌乳素腺瘤4例,生长激素腺瘤6例,促肾上腺皮质激素腺瘤3例,促甲状腺激素腺瘤1例,混合型腺瘤2例。总结患儿的临床表现、影像学表现、手术情况、并发症情况及预后。结果20例患儿中14例存在视力障碍,不同类型的腺瘤分别体现出与垂体激素相关的临床表现。多数患儿的肿瘤位于鞍内,部分患儿向鞍上及鞍旁发展,少数侵袭海绵窦内侧壁。20例患儿行开颅手术4例,中位手术时间为4.1 h;神经内镜下经鼻蝶窦入路16例,中位手术时间为2.4 h。14例患儿肿瘤全切,4例次全切,2例部分切除。并发症包括术中脑脊液鼻漏4例,垂体功能低下10例,嗅觉减退2例,颅内感染2例,一过性尿崩8例,长期性尿崩3例。患儿随访1~9年,6例复发,其中3例接受再次手术,2例接受药物治疗,1例接受立体定向放射外科治疗。14例伴有视力障碍的患儿均有不同程度的视力改善。结论儿童垂体腺瘤多见于大龄及青春期儿童。神经内镜下经鼻蝶窦手术是治疗儿童垂体腺瘤的重要手段,术后需要长期密切随访。Objective To explore the clinical characteristics and surgical approaches of pediatric pituitary adenoma(PPA).Methods From 2013 to 2021,the relevant data were retrospectively reviewed for 20 PPA children.Clinical manifestations,imaging findings,pathological characteristics,treatment strategies,complications and outcomes were analyzed.Inclusion criteria included age under 18 years,surgical treatment and pathologically confirmed PPA.Exclusion criteria were visceral lesions,coagulation abnormalities or nasal infection potentially endangering operative safety.There were nonfunctional adenomas(n=4),growth hormone adenomas(n=6),prolactin adenomas(n=4),adrenocorticotropic hormone adenomas(n=3),thyroid-stimulating hormone adenoma(n=1)and mixed adenomas(n=2).Ratio of male-to-female was 1∶1 and age range(11-17)years.Tumors were located predominantly in sella while sparsely in suprasella or parasella.Results Craniotomy was performed via the approaches of longitudinal fissure(n=1)and pterional(n=3).And endoscopic transsphenoidal approach was performed(n=16).Median operative duration was 4.1h in craniotomy group and 2.4h in endonasal group.The operative procedures included total resection(n=14),subtotal resection(n=4)and partial resection(n=2).Complications included intraoperative cerebrospinal fluid rhinorrhea(n=4),hypopituitarism(n=10),intracranial infection(n=2),transient diabetes insipidus(n=8),long-term diabetes insipidus(n=3)and hypo-olfaction(n=2).Six cases recurred during a follow-up period of(1-9)years.The interventions included reoperation(n=3),drug therapy(n=2)and stereotactic radiosurgery(n=1).And 14 children with impaired vision showed visual improvement.Conclusions PPA is more common in older children and adolescent than in younger children.Endoscopic transnasal transsphenoidal surgery is an important treatment of PPA.A long-time follow-up is necessary.

关 键 词：垂体腺瘤 蝶窦 开颅术 儿童 

分 类 号：R736.4[医药卫生—肿瘤]