垂体腺瘤假包膜囊外切除术的临床研究

Pseudocapsule based extracapsular resection of pituitary adenoma

目的 探讨垂体腺瘤行假包膜囊外切除术的临床意义.方法 选取2015年4月~2016年7月行经蝶窦入路切除垂体腺瘤的173例患者,根据假包膜囊外及囊内切除进行分组,对比其全切率、生物学治愈率及并发症情况.结果 173例患者中,90例发现假包膜（52.0%）,其中无功能型和生长激素型垂体腺瘤假包膜发现率较高.囊外切除组肿瘤全切率（95.6%）高于囊内切除组（88.0%）,但差异无统计学意义;功能型腺瘤中囊外切除组生物学治愈率亦较高（89.7%比71.4%）,差异有统计学意义（χ2=4.279,P〈0.05）;术中脑脊液漏发生率分别为47.8%和41.0%,术后脑脊液漏发生率为0;术后病理学证实假包膜有肿瘤细胞浸润.结论 垂体腺瘤假包膜囊外切除能够提高肿瘤全切率及功能型垂体腺瘤的生物学治愈率,且不增加术后并发症,是一种安全、有效的切除方式.

Objective To investigate the clinical significance of pseudocapsule based extracap-sular resection of pituitary adenomas.Methods Totals of 173 patients who underwent tumor resection from April 2015 to July 2016 were selected. All patients were divided into two groups according to pseudocapsule based extracapsular or intracapsular resection. Total removal rate, biology cure rate and complications were evaluated.Results In the 173 patients, pseudocapsule was found in 90 patients （52.0%） and mostly was found in non-functional and growth hormone secreting pituitary adenoma. No significant differences were found in to-tal removal rate between extracapsular resection group （95.6%） and intracapsular resection group （88.0%）. In patients with functional pituitary adenoma, biology cure rate of patients in extracapsular resection group was significantly higher than those in intracapsular resection group （89.7% vs 71.4%,χ2=4.279,P〈0.05）. The incidence of cerebrospinal fluid leak during surgery was 47.8% and 41.0% in extracapsular resection group and intracapsular resection group respectively. No cerebrospinal fluid leak was found after surgery. Postoperative pathology confirmed that pseudocapsules had tumor cell infiltration.Conclusions Pseudocapsule based extra-capsular resection is effective and safey for pituitary adenoma. It could increase total removal rate and increase biology cure rate in patients with functional pituitary adenoma without increasing postoperative complications.