术中CT在经鼻-蝶神经内镜下垂体瘤切除术中的应用

Intraoperative CT in endoscopic endonasal surgery for pituitary adenomas

目的探讨术中CT在经鼻-蝶神经内镜下垂体瘤切除术中的应用价值。方法南方医科大学珠江医院自2012年11月至2013年6月采用术中CT辅助经鼻一蝶神经内镜下行垂体瘤切除术患者37例，分析术中CT在手术过程中的应用及其对手术进程和手术结果的影响。结果每例垂体瘤患者术中一般行CT扫描1～3次，平均1．43次，每次扫描时间仅需50～60s，37例患者中术中扫描发现11例存在肿瘤残余，其中9例行进一步切除后，达到影像学肿瘤全切除6例，次全切除3例，另2例因肿瘤质地坚韧或与颈内动脉粘连紧密，仅行部分切除；初次影像学全切率为70.3％（26／37），在术中CT辅助下最终肿瘤影像学全切率达86．5％（32／371，提高了16．2％。术后无一例患者发生与CT检查相关并发症及严重手术并发症。结论经鼻一蝶神经内镜下垂体瘤切除术中应用CT实时扫描技术，为指导手术进程及实时判断手术结果提供了可靠的客观依据，从而提高肿瘤的全切率，有效减少不必要的盲目手术操作，提高了手术的安全性。

Objective To explore the value ofintraoperative CT （iCT） in endoscopic endonasal surgery for pituitary adenomas. Methods A retrospective analysis was conducted in the clinical data of 37 patients with pituitary adenomas performed endoscopic endonasal surgery with assistance of iCT in our hospital from November 2012 to June 2013. The influences of iCT on surgical process and results were analyzed. Results Intraoperative scanning was performed 1 to 3 times in each patient, averaging 1.43 times. The scanning time was only 50-60 s. Among the 37 patients, iCT revealed residual tumor in 11, 9 of which underwent further resection with total removal in 6 and subtotal in 3, and the tumors in the other two patients were unable to be resected because the adenomas were tenacious and adhered closely to the internal carotid artery. Finally, the rate of gross total removal increased from 70.3% to 86.5%, rising by 16.2%. No iCT related complications and severe surgical complication occurred. Conclusion The application of iCT in endoscopic endonasal surgery for pituitary adenomas provides objective evidence for the guidance of surgical procedure and real-time judgment of surgical results, which not only leads to higher percentage of tumor removal but also eliminates the unnecessary blind surgical manipulation to increase the safety of the operation.