内镜经鼻蝶入路手术治疗垂体脓肿

Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess

目的探讨内镜经鼻蝶入路手术治疗垂体脓肿的可行性及疗效。方法回顾性分析2000年1月至2011年12月经手术及病理证实为垂体脓肿的18例患者的临床病例资料及影像学特征。其中男6例，女12例，平均年龄48．5岁，平均病程5．8年。18例患者的主要临床表现包括头痛13例次、垂体功能紊乱10例次、尿崩症4例次、视觉功能障碍8例次、发热4例次。全部患者均采用全身麻醉下内镜经鼻蝶人路手术治疗垂体脓肿。记录手术后症状恢复情况及术后随访结果。结果术后随访6个月至6年，头痛缓解13例；垂体功能者恢复正常8例；尿崩症恢复正常3例；视力、视野改善6例。术后1例复发，再次行内镜经鼻蝶入路手术后治愈。结论内镜经鼻蝶人路微创手术治疗垂体脓肿是有效的治疗方法。

Objective To evaluate the effectiveness of transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess. Methods Eighteen pathologically diagnosed pituitary abscess were rescctcd throutb transsphenoidal endoscopic endonasal approach at Tianjing Huanhu hospital between January 2000 and December 2011. Retrospective analysis was done upon clinical presentations and imaging features. There were 6 males and 12 females. The average age was 48.5 years old and the average disease course was 5.8 years. The typical clinical manifestations included headache （13 cases ）, pituitary dysfunction （10 cases）, polyuriain （4 cases） visual interference （8 cases） and fever （4 cases）. All cases were resected by transsphenoidal endoscopic endonasal approach with general anesthesia. The postoperative symptoms and follow-up resuhs were recorded. Results All patients were followed up from 6 months to 6 years. Postoperatively,headache was recovered in 13 cases, visual was improved in 6 cases, hypopituitarism was relieved in 8 cases and polyuria was disappeared in 3 cases. One case was recurrent and cured by transsphenoidal endoscopic endonasal approach. Conclusions Transsphenoidal endoscopic endonasal approach for the surgery of pituitary abscess is effective.