神经内镜辅助下经蝶窦入路行蝶鞍区肿瘤切除术的临床研究

Clinical study of transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection

目的 探讨神经内镜辅助下经蝶窦入路行蝶鞍区肿瘤切除术的手术技巧.方法 回顾性分析71例神经内镜辅助下经蝶窦入路行蝶鞍区肿瘤切除术患者的临床资料.结果 71例患者中,垂体瘤67例（4例为垂体瘤术后复发）,Rathke囊肿4例;全切除54例,近全切除10例,大部分切除7例.术后出现短暂性尿崩症16例,顽固性低钠血症2例,脑脊液鼻漏1例,甲状腺功能减退1例,鼻出血、鼻腔粘连1例,嗅觉严重减退4例,脑梗死1例,无死亡患者.随访3个月,单侧鼻黏膜萎缩12例.结论 神经内镜辅助下经蝶窦入路治疗蝶鞍区肿瘤的方法安全有效,严重并发症少,但鼻腔部并发症不容忽视.

Objective To explore the surgical techniques of transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection. Methods The clinical data of 71 patients who had underwent transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection were retrospectively analyzed. Results Among the 71 patients, pituitary tumors was in 67 cases （including recurrent pituitary tumors 4 cases）, and Rathke cysts in 4 cases. A total of 54 cases had gross total resection, 10 cases had near total resection, and 7 cases had subtotal resection. Some patients had postoperative complications, including transient diabetes insipidus in 16 cases, refractory hyponatremia in 2 cases,cerebrospinal rhinorrhea in 1 case,hypothyroidism in 1 case,rhinorrhagia and synechia nasal in 1 case, hyposmia in 4 cases, and perioperative cerebral infarction in 1 case. There was no surgery related death. After 3 months＇ follow- up, 12 cases were found to have nasal mucosa atrophy. Conclusions The transsphenoidal approach neuroendoscope-assisted sella turcica tumor resection is safe and effective, with less serious complications, but the complications of nasal cavity should not be ignored.