神经内镜下经鼻蝶手术切除垂体瘤术后并发症探讨分析

Analysis of complications after endoscopic transsphenoidal surgery for pituitary adenoma

目的总结神经内镜下经鼻蝶手术切除垂体瘤术后并发症的发生原因、治疗和预防方法。方法回顾性分析由同一术者完成的61例神经内镜下经鼻蝶手术切除垂体瘤的临床资料,并对术后并发症进行分析。结果肿瘤全切除41例,次全切除20例。24例侵袭海绵窦中,肿瘤全切除12例,次全切除12例。平均手术时间70 min。术后视力下降均有所改善;38例功能性垂体腺瘤中,激素水平下降33例;头痛缓解22例。并发症情况:暂时性尿崩症6例,低钠血症6例,脑脊液漏6例,颅内感染1例,垂体功能降低3例,术区血肿1例,蝶窦炎症3例;经对症处理后,均痊愈或改善。结论内镜手术创伤小、术后并发症少,术前周密的手术计划和风险评估,了解垂体瘤生长特点,及术后严密观察可减少术后并发症、缩短住院时间。

Objective To summarize the causes, treatment and prevention methods of postoperative complications after endoscopic transsphenoidal surgery for pituitary adenoma. Methods Clinical data of 61 patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery were analyzed retrospectively, and the surgery was completed by the same surgeon, then the postoperative complications were analyzed. Results Total tumor removal was achieved in 41 patients and subtotal removal in 20. In 24 patients with cavernous sinus invasion, total tumor resection was achieved in 12 patients and subtotal resection in 12. The average operation time was 70 minutes. Postoperative diminution of vision was improved in all the patients. In 38 patients with fimctional pituitary adenoma, hormone levels declined after surgery in 33. The headache was relieved in 22 patients. Postoperative complications included temporary diabetes insipidus in 6 patients, hyponatremia in 6, cerebrospinal fluid leakage in 6, intracranial infection in 1, hypopituitarism in 3, postoperative hematoma in 1, sphenoid sinus inflammation in 3. All the complications disappeared or improved after proper treatment. Conclusions Endoscopic surgery is minimally invasive with fewer postoperative complications. The careful surgical planning and risk assessment before operation, understanding growth characteristics of pituitary tumor, and close observation after operation can reduce postoperative complications and shorten hospitalization time.