经鼻蝶神经内镜结合磨钻辅助下垂体瘤切除术临床分析

Clinical efficacy of neuroendoscopic surgery combined with drill via endonasal transsphenoidal approach for the treatment of patients with pituitary adenomas

目的探讨经鼻蝶神经内镜结合磨钻辅助下切除垂体瘤的有效性和安全性。方法回顾性分析我院2009-05—2012-01 48例择期行经鼻蝶神经内镜垂体瘤切除术患者的临床资料,所有患者术中均使用磨钻辅助,术后行视力、神经影像和内分泌检查,总结手术技巧和临床疗效。结果所有患者均手术成功,无死亡。肿瘤全切除37例(77.1%),大部分切除8例(16.7%),部分切除3例(6.3%);术后视力好转22例(84.6%,22/26),视野缺损好转9例(81.8%,9/11),头痛消失或好转10例(71.4%,10/14);术后3个月复查,48例患者平均PRL水平由术前(298.31±143.14)μg/L降至术后(46.38±31.47)μg/L,平均GH水平由术前(48.14±20.38)ng/L降至术后(13.29±5.58)ng/L,差异有统计学意义(P<0.05)。手术并发症:发生脑脊液漏者5例,暂时性尿崩症者13例,动眼神经或外展神经一过性麻痹2例,治疗后病情均得到控制。结论经鼻蝶神经内镜垂体瘤切除术是一种微创、安全、有效的方法,结合磨钻辅助可进一步增加其安全性和有效性。

Objective To investigate clinical efficacy and safety of neuroendoscopic surgery combined with drill via endonasal transsphenoidal approach on pituitary adenomas. Methods Clinical data of 48 cases in our hospital from May 2009 to January 2012 with neuroendoscopic surgery combined with drill via endonasal transsphenoidal approach were retrospectively an- alyzed. Burr auxiliary was used in all patients. Neuro-ophthalmological, neuroimaging and endocrine examination were performed after surgery. Surgical techniques and clinical outcomes were summarized. Results Total resection was achieved in 37 cases （77.1%）, subtotal resection in 8（16.7%） and partial resection in 3 （6.3%）. The visual acuity was improved in 22 cases （84.6%, 22/26）, defect of visual field was improved in 9 （81.8%, 9/11） and headache was disappeared or improved in 10 （71.4%, 10/14）. The high preoperative prolactin （PRL） level in 48 patients was obviously decreased from （298.31 ± 143.14） ;g/L to （46. 38±31.47） μg/L and high preoperative growth hormone （GH） level was obviously decreased from （48.14 ± 20.38） ng/L to（13.29±5.58）ng/L 3 months after surgery（P〈0.05）. Surgical complications： cerebrospinal fluid leakage in 5 patients, temporary diabetes insipidus in 13 cases and outreach or oculomotor nerve palsy in 2 cases. Conclusion Endoscopic transsphenoidal resection of pituitary tumors is a minimally invasive, safe and effective method. The safety and effectiveness can be further increased through the combination with burr.