经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤

Endoscopic endonasal transsphenoidal surgery for pituitary adenomas

目的探讨神经内镜在经鼻蝶入路手术切除垂体腺瘤术中的应用价值和术中注意事项。方法回顾性分析221例垂体腺瘤手术病例的临床资料。手采用经单侧鼻孔蝶窦入路内镜下切除肿瘤,必要时在导航确认下进行。术后3个月复查头颅增强MRI判断肿瘤切除情况。结果术中无定位错误病例,无大的血管和神经损伤病例。肿瘤全切除178例,次全切除37例,大部切除6例。术后死亡3例。术后无永久性尿崩和脑脊液漏病例,2例围手术期鼻腔大出血,治疗后好转。术前视力和视野障碍病人术后无恶化。结论内镜结合导航经鼻蝶入路切除垂体腺瘤创伤小,导航可增加手术安全性和扩大手术适应症;充分的术前准备和规范的术中操作是预防术后并发症、提高手术疗效的关键。

Objective To explore the value of endoscopy combined with neuronavigation to endonasal transsphenoidal surgery for pituitary adenomas in order to improve the therapeutic effects on them. Methods The clinical data of 221 patients with large pituitary adenomas who were treated by endoscopic neuronavigational endonasal transsphenidal surgery were analyzed retrospectively. The extents of removal of the adenomas were assessed by enhanced head MRI 1 and 3 months after the operation in all the patients. Results Three patients died 8 days, 3 months and 2 years respectively after the surgery. MRI 3 months after the operation showed that the total resection of the ademomas was achieved in 176 patients, subtotal in 37 and partial in 6. Two patients who had the endonasal gross bleeding after the surgery were cured.The visual power and field disturbances were not deteriorated after the surgery in all the patients. There was no permanence diabetes insipidus and leakage of cerebrospinal fluid after the surgery in all the patients. Conclusions It is minimally invasive to use endoscopycombined with neuronavigation during endonasal transsphenoidal surgery for large pituitary adenomas. The operative safety and indication may be enhanced by the endoscopic neuronavigational endonasal transsphenoidal surgery in the patients with large pituitary adenomas, in whom the prognoses may be improved by the ample preoperative preparation, standard operative procedure and positive prevention of the postoperative complications.