内镜下经鼻蝶入路垂体腺瘤切除术

Endoscopic endonasal transsphenoidal surgery for pituitary adenomas

目的探讨内镜下经鼻蝶入路切除垂体腺瘤的方法、疗效和并发症。方法回顾性分析2002年6月至2005年8月,在我院神经外科接受内镜下经鼻蝶入路切除术的66例垂体腺瘤的临床资料。男性32例,女性34例,年龄在18岁到73岁,平均44岁。其中微腺瘤11例,大腺瘤55例;无功能腺瘤46例,泌乳素腺瘤13例,生长激素腺瘤7例。结果全切除49例,近全切除12例,大部切除5例。微腺瘤全切除10例,近全切除1例;鞍内大腺瘤全切除23例,近全切除4例;鞍内和鞍上大腺瘤全切除16例,近全切除4例,大部切除3例;侵及海绵窦的5例大腺瘤3例近全切除,2例大部切除。所有病例中,术后有28例尿崩症,5例垂体前叶功能低下,1例颅内感染和1例鼻窦炎。结论内镜下切除垂体腺瘤是一种安全、有效和并发症少的治疗方法,尤其适合治疗微小腺瘤和局限于鞍内和蝶窦的垂体腺瘤。

Objective To assess the technique, effect and complications of endoscopic endonasal transsphenoidal surgery for pituitary adenomas. Methods A retrospective analysis was conducted in 66 treated patients underwent an endoscopic endonasal transsphenoidal surgery from June 2002 to August 2005 in Department of Neurosurgery. Of the 66 patients, 32 males and 34 females, aged from 18 to 73 with a mean age of 44 years. Microadenomas were in 11 patients, macroadenomas in 55; nonsecreting adenomas in 46, prolactinomas in 13, and growth hormone-secreting adenomas in 7. Results Total resection was accomplished in 49 out of the 66 patients, subtotal resection in 12 and partial resection in 5 ; total resection of the microadenomas was accomplished in 10 and subtotal resection in 1 ; total resection of intrasellar adenomas was accomplished in 23 and subtotal resection in 4; total resection of intrasellar and supprasellar adenomas was accomplished in 16, subtotal resection in 4 and partial resection in 3 ; among 5 cases of macroadenomas involving cavernous sinus, subtotal resection was performed in 3 and partial resection in 2 cases. In all cases of adenomas, diabetes insipidus occurred during postoperative course in 28 patients, anterior pituitary insufficiency occurred in 5 patients, meningitis in 1 patient and sinusitis in 1 patient. Conclusion Endoscopic endonasal transsphenoidal technique is safe and effective for treatment of pituitary adenomas with less complications, especially for treatment of microadenoma and intrasellar adenoma.