内镜垂体瘤切除术中鞍膈形态与肿瘤残余及并发症的关系

Relationship between Diaphragma Sellae Morphology and Residual Tumor and Complications during Nasal Endoscopic Transsphenoidal Resection of Pituitary Adenoma

目的：探讨经鼻内镜垂体瘤切除术中鞍膈下降形态与肿瘤残余、尿崩症及术中脑脊液漏的关系。方法回顾分析2012年2月～2013年3月我科80例鼻内镜垂体瘤切除术的临床资料。术中肿瘤切除后鞍膈下降形态分为4型：A型：鞍膈以垂体柄为中心对称性降至鞍区；B型：鞍膈非对称性降至鞍区，垂体柄偏向一侧；C型：鞍膈对称性下降，垂体柄移至鞍背；D型：鞍膈未或仅有轻微下降，垂体柄位置模糊不清。结果 A、B、C、D四型鞍膈的肿瘤残余率、尿崩症发生率及脑脊液漏发生率有统计学差异（χ2＝11．069，P＝0．011；χ2＝11．483，P＝0．009；χ2＝8．890，P＝0．031）。肿瘤残余多见于B、D型鞍膈，肿瘤残余发生率与A、C型鞍膈有统计学差异（Z＝-2．409，P＝0．016；Z＝-2．062，P＝0．039；Z＝-2．477，P＝0．013；Z＝-2．245，P＝0．025），但B型与D型肿瘤残余率无统计学差异（Z＝-0．791，P＝0．429）。尿崩症、术中脑脊液漏多见于A、C型鞍膈，发生率与B、D型鞍膈有统计学差异（P＜0．05），但A型与C型尿崩症、脑脊液漏发生率无统计学差异（Z＝-0．195， P＝0.846；Z＝-0．362，P＝0．717）。结论鞍膈下降形态可以作为肿瘤残余、尿崩症及术中脑脊液漏的一个解剖参考。

Objective To explore the relationship of descent shape of diaphragm sellae with residual tumor ,diabetes insipidus （ DI ） and intraoperative cerebrospinal fluid （ CSF ） leakage during nasal endoscopic transsphenoidal resection of pituitary macroadenoma . Methods A total of 80 cases of pituitary macroadenoma confirmed by pathology from February 2012 to March 2013 were retrospectively analyzed .All the patients received nasal endoscopic resection of pituitary adenoma .We classified descent shape of diaphragm sellae as four types as follows .Type A： diaphragm sellae symmetrically descended to sella region with pituitary stalk as center;type B： diaphragm sellae asymmetrically descended to sella region , leading to the displacement of pituitary stalk; type C：diaphragm sellae symmetrically descended to sella region , and pituitary stalk moved to dorsum sellae;type D：diaphragm sellae didn ’ t descend or descended slightly with indistinct location of pituitary stalk . Results There were statistical differences in tumor residual rate, DI and intraoperative CSF leakage among the four types of diaphragm sellae （χ2 =11.069, P=0.011;χ2 =11.483, P=0.009;χ2 =8.890, P=0.031）.There was more residual tumor in type B and D than that of type A and C （Z=-2.409, P=0.016; Z=-2.062, P=0.039;Z=-2.447, P=0.013;Z=-2.245, P=0.025）.No statistical difference was found between type B and D in residual tumor （Z=-0.791, P=0.429）.More DI and intraoperative CSF leakage were found in type A and C than that of type B and D （P＆lt;0.05）.There were no statistical differences between type A and C in DI and intraoperative CSF leakage （Z=-0.195, P=0.846;Z=-0.362, P=0.717）. Conclusion Descent shape of diaphragma sellae may serve as a reference for residual tumor, DI and intraoperative CSF leakage .