神经内镜经双鼻孔入路假包膜外切除垂体腺瘤

Endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach

目的 探讨神经内镜经双鼻孔入路假包膜外切除垂体腺瘤的手术经验及临床疗效.方法 回顾性分析2015年1月至2016年12月南昌大学第一附属医院神经外科采用神经内镜经双鼻孔入路切除254例垂体腺瘤患者的临床资料.筛选出经假包膜外切除的133例患者,综合评价其手术效果及随访结果.结果 经假包膜外切除垂体腺瘤的133例患者中,124例（93.2％）肿瘤达到全切除,9例（6.8％）达到次全切除.术后84.7％ （61/72）的患者视力视野改善,73.7％ （42/57）的患者头痛症状缓解.术前垂体功能正常的62例无功能性腺瘤中,术后42例（67.7％）仍保持正常水平,20例（32.3％）出现垂体功能部分减退;术前垂体功能部分减退的23例无功能性腺瘤患者中,术后10例（43.5％）改善,10例（43.5％）维持术前水平,3例（13.0％）垂体功能减退加重;48例激素分泌性腺瘤患者中,术后激素水平缓解44例（91.7％）.术中鞍膈破裂52例（39.1％）,术后脑脊液漏6例（4.5％）,术后尿崩27例（20.3％）,均为短暂性尿崩,无死亡病例.术后随访10 ～ 33个月,平均（23.6±7.0）个月,复发3例（2.4％）.结论 神经内镜经双鼻孔入路假包膜外切除垂体腺瘤全切除率较高,复发率较低,可有效缓解患者的临床症状及改善内分泌学指标,且并发症较少.

 Objective To explore our surgical experience and clinical outcome of endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach.Methods A retrospective review of clinical data of 254 patients who were treated for pituitary adenoma by endoscopic surgery using bilateral endonasal approach within the time frame of January 2015-December 2016 at Department of Neurosurgery,First Affiliated Hospital of Nanchang University.The patients who experienced extrapseudocapsular resection were selected for general evaluation of surgical outcome and follow-up results.Results A total of 133 cases underwent endoscopic endonasal extrapseudocapsular resection.Among those,124 （93.2%） cases achieved gross total resection and subtotal resection was achieved in 9 （6.8%） cases.Postoperative improvement of vision and visual field occurred in 61 （84.7%） cases and 42 （73.7%） cases achieved postoperative remission of headache.Among 62 non-functional pituitary adenomas with normal preoperative pituitary function,42 （67.7%） cases preserved normal pituitary function after operation and the other 20 （32.3%） cases developed partial hypopituitarism.Out of 23 non-functional pituitary adenomas with preoperative partial hypopituitarism,postoperative improvement was reported in 10 （43.5%） cases,persistent hypopituitarism in 10 （43.5%） cases and aggravation in 3 （13.0%） cases.Overall,44 （91.7%） cases showed biochemical remission in endocrine-active pituitary adenomas after operation.Intraoperative rupture of sellar diaphragm was noted in 52 （39.1%） cases,postoperative CSF （cerebrospinal fluid） leakage in 6 （4.5%） cases,and transient diabetes insipidus （DI） in 27 （20.3%） cases.No death occurred during the follow-up period.Tumor recurrence occurred in 3 （2.4%） cases during the follow-up period lasting for 23.6 ± 7.0 months.Conclusions Endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach could achieve high rate of gross total resection and low rate of tumor recurrence,effectively alleviate the patients＇ clinical symptoms,increase surgical remission rate in endocrine-active adenomas with less complications.