垂体腺瘤MRI诊断与单鼻孔经蝶窦入路切除

Resection of MRI Diagnosis and Transnasal Transsphenoidal Approach in Pituitary Adenomas

目的探讨垂体MRI动态增强扫描对垂体微腺瘤的诊断作用及显微镜辅助单鼻孔-经蝶窦入路切除垂体腺瘤的优点和适应症。方法对怀疑垂体腺瘤的334例患者先行常规MRI平扫,对未见垂体腺瘤的患者再行垂体MRI动态增强扫描。垂体腺瘤手术的患者,全部采用显微神经外科技术经经单鼻孔-蝶入路切除垂体腺瘤。结果334例患者经MR平扫或垂体MRI动态增强扫描后,发现垂体腺瘤326人。其中,MRI常规平扫后发现垂体腺瘤297人,MRI常规平扫后未发现垂体腺瘤的37人经垂体MRI动态增强扫描发现垂体微腺瘤29人。发现垂体腺瘤的326人中,手术316例。手术患者中,252例近全切除,50例大部切除。无手术死亡,术后16例脑脊液鼻漏行腰大池引流治愈,余无手术并发症。结论MRI平扫结合MRI动态增强扫描诊断与单鼻孔-经蝶窦入路切除肿瘤的方法相结合,可取得垂体腺瘤良好的治疗效果。

Objective To observe the effect of dynamic MR imagling（DMRI） for diagnosis of Pituitary Adenomas, and to discuss the advantage of the resection of Pituitary Adenomas with transnasal trassphenoidal approach assistanted with microscopy. Methods We tested 334 patients used MRI, then tested some of them used DMRI. Whole patients who suffered from the pituitary adenomas, were discussed retrospectively. Whole patients underwernt operation were treated by the transnasal transspennoidal pituitary region surgery. Results 326 pituitary adenomas were found by MR or DMRI in 334 patients. 297 pituitary adenomas were found by MR, 29 pituitary adenomas were found by DMRI. 316 patients underwent the transnasal transspennoidal pituitary region surgery. In 252 of 316 patients initial and 3 months postoperative imaging revealed complete tumor resection and in 50 of 316 patients revealed subtotal tumor resection. No patient died of the operation, in 16 of 316 patients developed the cerebrospinal fluid rhinorrbea after operation. All these patients have doing well after drainge of subaraehnoid space of terminal cistern. No other complications related to the operation occurred. Conclusion It can be got fine results, which use MRI and dynamic MR imaging for diagnosis, and use the way of transnasal trassphenoidal approach assistanted with microscopy in Pituitary Adenomas.