内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位的可行性

Feasibility of Endoscope-assisted Microscope Guided Expanding Endonasal Transsphenoidal Approach for Sellar Region Occupation Lesions Resection

目的分析内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位的可行性。方法选取2014年9月—2016年12月宿迁市第一人民医院收治的鞍区占位患者8例,均经颅脑磁共振成像(MRI)检查证实并经内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位,分析其治疗结果及并发症发生情况。结果 8例患者术后均立即复查颅脑CT,其中7例患者无术后出血,1例患者示鞍区高密度影,考虑术区渗血并填塞自体脂肪组织。8例患者术后3 d复查颅脑MRI,其中7例示肿瘤完全清除,1例有少量残留。8例患者术后均出现不同程度尿崩症,经口服醋酸去氨加压素后好转,无一例出现术后脑脊液鼻漏、颅内感染;随访半年无一例复发。结论内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位安全可行,对肿瘤清除效果好且并发症较少。

Objective To analyze the feasibility of endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection. Methods A total of 8 patients with sellar region occupation lesions were selected in First People＇s Hospital of Suqian from September 20104 to December 2016,all of them were confirmed by craniocerebral MRI and received endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection,the therapeutic outcome and incidence of complications were analyzed.Results All of the 8 patients received craniocerebral CT reexamination immediately after operation,thereinto 7 cases did not occurred postoperative bleeding,1 case found high density shadow in sellar region,which was considered as errhysis of operating zone and packed with fat autograft. All of the 8 patients received craniocerebral MRI 3 days after operation,thereinto 7 cases got complete removal of tumor,1 case with little residual tumor. All of the 8 patients occurred different extent diabetes insipidus,and they take a turn for the better after taking desmopressin acetate orally,no one of them occurred cerebrospinal fluid rhinorrheaor intracranial infection,and no one occurred during the 6-month follow-up. Conclusion Endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection is safe and feasible,has good tumor removal effect and low risk of complications.