经鼻蝶入路内镜下切除垂体腺瘤39例临床分析

Surgical treatment of pituitary adenomas via endoscopic transsphenoidal approach： a clinical analysis of 39 cases

目的 探讨经鼻蝶入路内镜下切除垂体腺瘤的手术技巧和适应证. 方法 南方医科大学珠江医院耳鼻咽喉头颈外科白2000年1月至2008年1月采用经鼻蝶入路内镜下肿瘤切除术治疗垂体腺瘤患者39例,其中非功能性腺瘤2例,功能性腺瘤37例,回顾性分析患者的临床资料、手术效果及相关并发症. 结果 37例功能性腺瘤全部切除（94.9%）,2例非功能性腺瘤（Ⅴ期）因瘤组织侵犯鞍旁,术野操作受限术中未能全部切除（5.1%）,患者于术后一个月行局部放射治疗,术后3年仍带瘤生存;术后48h内出现一过性多尿或尿崩者11例,脑脊液鼻漏者2例,均经治疗后痊愈;随访发现1例非功能性腺瘤患者存在单颞侧视野缺损,头痛症状完全消失或减轻16例（88.9%）,泌乳症状减轻或消失11例（91.7%）,视力恢复17例（100%）,性功能好转7例（77.8%）.37例功能性腺瘤患者激素水平均较术前明显好转或恢复正常. 结论 经鼻蝶人路内镜下切除垂体腺瘤具有简便、安全、微创的优点,只要正确地掌握好此类手术的适应证,在完整切除瘤体的前提下,能有效避免并发症,获得满意的治疗效果.

Objective To evaluate the indications and the surgical technique of endoscopic transsphenoidal approach in the surgical treatment of pituitary adenomas. Methods We retrospectively analyzed the surgical effectiveness and complications of transsphenoidal approach under endoscope in treating 39 patients suffering from pituitary adenomas, including 37 with functional adenomas and 2 with non-functional adenomas. Results In all the patients with functional adenomas,tumors were totally resected. The 2 patients with non-functional adenoma invaded the seller obtained partial resection, and thus, postoperative radiotherapy was performed and preoperative symptoms were improved. All patients had no serious complications. All cases were followed up for 6-36 months： 1 had temporally visual loss; 11 appeared transient polyuria or diabetes insipidus; 2 developed cerebrospinal rhinorrhea, and they were cured after the treatment; headache was disappeared or relieved in 11, and sexual function got improvement in 7; the high preoperative PRL level was decreased to normal value in 37 patients after the surgery. Conclusion Endoscopic transsphenoidal technique, a safe, minimally invasive and efficient procedure for removing pituitary adenomas, offers simple and rapid access to the sella turcica and also provide direct visualization, thus improving the surgeon＇s ability to resect the tumors.