神经内镜经鼻蝶窦治疗老年无功能性垂体腺瘤

Treatment of non-functional pituitary adenoma in the elderly with endoscopic endonasal transsphenoidal approach

目的 探讨神经内镜经鼻蝶窦手术治疗老年无功能性垂体腺瘤的安全性、有效性.方法 回顾性分析南京医科大学附属无锡第二医院神经外科2009年1月至2014年12月,采用神经内镜经鼻蝶窦手术治疗的≥65岁无功能性垂体腺瘤患者的临床资料,共34例.其中经单侧鼻孔蝶窦手术的12例,经双鼻孔蝶窦手术的22例.结果 肿瘤全切除27例（79.4％）,近全切除4例（11.8％）,大部分切除2例（5.9％）,死亡1例（2.9％）.术后视力改善26例（92.9％,26/28）,无变化2例（7.1％,2/28）.术后尿崩10例（29.4％）;脑脊液鼻漏2例（5.9％）;2例（5.9％）出现新的垂体功能低下.30例获得3个月至5年的随访,垂体功能低下10例,嗅觉丧失1例,鼻窦炎1例,鼻衄1例.6例肿瘤残留的患者中,2例复发后予以放射治疗,4例随访观察.结论 虽然老年无功能性垂体腺瘤患者的手术风险相对较高,但通过加强围手术期多学科协作,采用神经内镜经鼻蝶窦手术治疗是安全、可行的.

Objective To investigate the safety and effectiveness of endoscopic endonasal transsphenoidal surgery in old patients with non-functional pituitary adenoma. Methods From January 2009 to December 2014, the clinical data of 34 patients （≥65 years） with non-functional pituitary adenoma treated with endoscopic endonasal transsphenoidal surgery at the Department of Neurosurgery, Wuxi Second Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. Twelve patients were treated unilaterally by transnasal endoscopic operation and 22 were treated bilaterally by transanal endoscopic surgery. Results The tumors of 27 patients （79.4%） were reseeted totally, 4 （ l1. 8% ） were resected near totally, 2 （5.9%） were resectcd subtotlly, and 1 （2.9%） died. The postoperative visual acuity was improved in 26 cases （92.9%, 26/28） and did not have any change in 2 cases （7. 1%, 2/28）. Ten patients （29.4%） had postoperative diabetes insipidus, 2 （5.9%） had cerebrospinal fluid rhinorrhea and 2 had new hypopituitarism. Thirty patients were followed up for 3 months to 5 years. Ten patients had hypopituitarism, 1 had anosmia, 1 had sinusitis, and 1 had epistaxis. Of the 6 patients with residual tumor, 2 were treated with radiation therapy after recurrence. Conclusions Although the operation risk of the elderly patients with non-functional pituitary adenoma is relatively high, using endoscopic endonasal transsphenoidal surgery is safe and feasible through the strengthening of per!operative multidisciplinary collaboration.