内镜经鼻垂体腺瘤切除术

Endoscopic endonasal transsphenoidal surgery for pituitary adenoma

目的探讨内镜经鼻垂体腺瘤切除术的外科技术。方法总结2003年9月至2006年3月100例内镜经鼻垂体腺瘤手术病人的临床资料。其中微腺瘤30例，大腺瘤35例，巨大腺瘤35例。功能性腺瘤68例，无功能性腺瘤32例。头痛82例，视力减退伴视野缺损76例，失明3例，闭经、泌乳36例，肢端肥大26例，垂体功能低下15例，其他症状者6例。结果术中内镜下肿瘤全部切除93例，大部切除7例，7例均为质地硬韧的纤维型腺瘤。术后短暂性尿崩症32例；脑脊液鼻漏5例。术后随访平均28个月，肿瘤残余者10例；12例肿瘤复发，10例再次行经蝶手术，2例行开颅手术；术后内分泌症状改善不明显者，有11例行溴隐亭治疗，18例病人行伽玛刀治疗。结论内镜经鼻垂体腺瘤切除术是一种安全、有效、微创的外科技术。

Objective To describe the technique of endoscopic endonasal transsphenoidal surgery for treatment of pituitary adenoma. Method Clinical data of 100 patients with pituitary adenoma that underwent endoscopic endonasal transsphenoidal surgery between September 2003 and March 2006 was analyzed. 30 patients had microadenomas, 35 patients macroadenomas, and 35 patients gigantic adenomas. 68 patients had hormone secreting adenomas, 32 had non-functioning adenomas. All operations were performed through a nostril using pure rigid endoscopes. Results Among the 100 patients, total resection was in 93 patients, subtotal resection in 7 patients. 32 patients developed postoperative diabetes insipidus, 5 developed CSF leakage. All patients were followed by mean 28 months, residual tumor was found in 10 patients. Among 12 patients with tumor recurrence, 10 performed second endoscopic endonasal surgery and 2 underwent transcranial surgery. 18 patients were treated with gamma knife surgery and 11 patients were treated with a course of hromocriptine therapy. Conclusions Endoscopic endonasal transsphenoidal surgery is a mini-invasive surgical technique for treatment of pituitary adenomas.