内镜经鼻蝶入路手术治疗垂体瘤

Treatment of pituitary tumors via endoscopic endonasal transsphenoidal approach

目的探索神经内镜在经蝶手术中的临床意义和应用前景。方法2000年5月～2006年5月共治疗垂体瘤678例,术前均行影像学(CT和MRI)及血液内分泌激素检查,且均在内镜下经鼻蝶手术切除病变。420例获得6～24个月的随访。结果肿瘤全切543例(80.1%),次全切除118例(17.4%),部分切除17例(2.5%)。术后临床症状改善643例(98%)。术后复查内分泌激素均有所改善。21例术后出现并发症,包括蛛网膜下腔出血、鼻腔出血、鼻部黏膜局限性感染、外鼻孔缩窄和脑脊液漏。420例随访病人中,4例在术后2年内复发。结论内镜经鼻蝶手术治疗垂体瘤,创伤小,显露清楚,切除肿瘤相对完全,操作简便、安全,术后病人反应轻,住院时间短。随着科学技术的进步,神经内镜经鼻蝶入路手术治疗垂体瘤必将得到不断发展和完善。

Objective To explore the clinical significance and future perspective of neuroendoscopy in transsphenoidal surgery. Methods From May 2000 to May 2006, 678 cases of pituitary adenoma were treated by endoscopic endonasal transsphenoidal surgery. All the patients received neuroimaging （MR andCT） and endocrinological examinations before the surgery. Four hundred and twenty patients got a follow-up of 6-24 months. Results The tumor removal was total in 543 （80.1%） cases, subtotal in 118 （17.4%）, and partial in 17 （2.5%）. Six hundred and forty-three （98%） patients achieved an improvement in clinical symptom after the operation. The blood endocrine status aider the operation also achieved an improvement. Postoperative complications, including subarachnoid hemorrhage, nasal bleeding, nasal mucosal inflammation, nostril stenoses, nasal cerebrospinal fluid leaks, occurred in twenty-one patients. Among the 420 follow-up patients, 4 had relapse at 2 years aider the first operation. Conclusion The endoscopic transsphenoidal surgery for pituitary tumors is of advantages as minimal invasiveness, clear exposure of operation field, relatively complete resection of tumor, simple operation, safety, mild response and shorter hospitalization time. With scientific and technological advance, it will be developed and perfected step by step.