内镜辅助经蝶入路垂体腺瘤手术83例报告

Endoscopic-assisted Transsphenoidal Approach for the Resection of Pituitary Adenoma

目的探讨内镜辅助经蝶入路垂体腺瘤的手术治疗方法。方法 2004年6月～2012年6月,对83例垂体腺瘤在内镜辅助下经单鼻孔鼻中隔中段入路治疗。先用内镜探明蝶窦开口,显露鞍底,充分扩大鞍底开口,按先后下、再两侧、之后前上的顺序刮除肿瘤。最后内镜鞍内确认有无肿瘤残余。结果 83例均顺利完成手术,无死亡。62例视力视野改变者中,术后视力视野改善55例。内分泌激素2周内恢复正常26例,改善30例。术后3个月磁共振复查肿瘤未见残余49例,肿瘤部分残余(残余<50%)30例,大部残余(残余>50%)4例。结论经鼻蝶入路适用于绝大多数垂体腺瘤手术,鞍底骨质切除范围与肿瘤切除次序是经蝶入路垂体腺瘤全切除的要点,内镜辅助下手术有视野清晰、肿瘤切除彻底等优点。

Objective To explore the technique of transsphenoidal approach surgery under endoscopic assistance for pituitary adenoma. Methods Totally 83 patients with pituitary adenoma, who were admitted to our hospital from June 2004 to June 2012, were enrolled into this study. Endoscopic-assisted procedure was performed on the patients via a single-nostril approach through the middle nasal septum. After exploring the opening of the sphenoidal sinus, we extended the gap at the sella floor, and then removed the adenoma starting from the posterior part, followed by the bilateral parts and then the anterior part. Residual tumor tissues were detected by endoscopy at the end of the procedure. Results The procedure was completed in all the 83 patients, and none of them died. Among the 83 cases, 55 out of the 62 patients who had vision and visual field change, were improved. The level of hormones were recovered after two weeks of operation in 26 patients, and improved in 30. Follow-up by MRI after three months of operation showed no residual tumor tissues in 49 patients, residual tissues 〈 50% in 30, and 〉 50% in 4. Conclusions Transsphenoidal approach suits most of the operations for pituitary adenoma. The keys of the procedure include the extent of seller floor resection, and the order of tumor resection. Endoscopic-assisted procedure is superior in keeping surgical filed clear and removing the tumor completely.