经鼻蝶神经内镜结合磨钻辅助下垂体瘤切除术

Treatment of pituitary adenomas by neuroendoscopic surgery combined with drill v/a endonasal transsphenoidal approach

目的探讨神经内镜结合磨钻辅助下切除垂体瘤的手术技巧和手术经验。方法河北省衡水市哈励逊国际和平医院神经外科自2007年8月至2011年7月应用神经内镜结合磨钻辅助下切除垂体瘤29例，回顾性分析患者的临床资料，总结手术技巧及经验。结果肿瘤全切除19例（65．5％），近全切除8例（27．6％），部分切除2例（6．9％），发生脑脊液漏患者4例，暂时性尿崩症27例，治疗后均得到控制。患者术后随访3～8个月，术后视力好转15例（83．33％），视野缺损好转8例（80％），头痛消失或好转9例（81．82％），术后3个月复查15例患者PRL水平由术前的（304．55±181．30）μg／L降至术后的（43．27±28．75）μg／L，6例患者GH水平由术前的（48．16±22．36）ng／L下降至术后的（14．03±4．57）ng／L，差异有统计学意义（P〈0．05）。结论经鼻蝶神经内镜结合磨钻辅助下垂体瘤切除手术是一种安全、微创、有效的方法。

Objective To evaluate the surgical technique and experience of endoscopic endonasal transsphenoidal approach combined with drill in surgical treatment of pituitary adenomas. Methods We retrospectively analyzed the clinical data of 29 patients suffered from pituitary adenomas, collected from September 2007 to August 2011 in our hospital, and the surgical technique and experience of endoscopic endonasal transsphenoidal approach in treating them. Results Total resection was achieved in 19 patients （65.5%）, subtotal resection in 8 （27.6%） and partial resection in 2 （6.9%）. Cerebrospinal leak appeared in 4 patients and temporary diatetes insipidus in 27 patients, and all these complications were controlled after treatment. Follow-up was performed for 3-8 months; the acuity of vision was improved in 15 patients （83.33%）; the defect of visual field was improved in 8 （80%）; headache was disappeared or relieved in 9 （81.82%）. The high preoperative prolactin （PRL） level in 15 patients was obviously decreased from （[304.55±181.30] μg/L） to （[43.27±28.75] μg/L） 3 months after the surgery （P〈0.05）; the high preoperative growth hormone （GH） level in 6 patients was obviously decreased from （[48.16±22.36] ng/L） to （[14.03±4.57] ng/L） 3 months after the surgery （P〈0.05）. Conclusion Neuroendoscopic surgery combined with drill via endonasal transsphenoidal approach in the treatment of pituitary adenomas is a safe, minimally invasive and efficient procedure.