改良神经内镜联合显微镜下经鼻蝶入路手术切除垂体腺瘤

Modified neuroendoscopy combined with microsurgical transsphenoidal approach for pituitary adenoma

目的探讨改良的神经内镜联合显微镜下经鼻蝶入路手术切除垂体腺瘤患者的临床效果、手术技巧、术后处理和临床可行性.方法选取河南大学第一附属医院2015-01-2017-12经改良的神经内镜联合显微镜下经鼻蝶入路手术治疗的64例垂体腺瘤患者,先显微镜代替神经内镜常规内镜下操作方法打开蝶窦,暴露肿瘤组织,后置入神经内镜切除肿瘤组织.分析术后患者临床症状改善、肿瘤切除率、术后并发症、手术时间及出血量.结果术后64例患者头痛、视力视野障碍、激素水平异常等临床症状较术前均得到改善;61例患者肿瘤SimposonⅠ级切除,3例Ⅱ级切除,肿瘤全切率95.31%;手术时间(65.35±15.65)m in,术中出血量(45±5.6)m L,均较以往单纯显微镜下、单纯神经内镜下手术时间明显缩短,出血量明显减少.术后出现脑脊液鼻漏2例,嗅觉暂时障碍1例,短暂尿崩4例,术后并发症总体发生率10.93%,给予腰大池置管引流、鼻腔冲洗、醋酸去氨加压素治疗后术后并发症均消失,随访3~6个月未出现肿瘤复发、迟发型脑脊液鼻漏、激素水平异常等并发症.结论改良神经内镜联合显微镜下经鼻蝶入路手术切除垂体腺瘤,术中出血少,手术时间短,临床疗效确定.

Objective To investigate the clinical effects,surgical techniques,postoperative management and clinical feasibility of modified neuroendoscopy combined with microsurgical transsphenoidal approach for the removal of pituitary adenomas. Methods A retrospective study was performed on 64 patients with pituitary adenoma who underwent modified neuroendoscopy combined with microsurgical transsphenoidal approach in the First Affiliated Hospital of Henan University from January 2015 to December 2017.First microscope instead of neuroendoscopy conventional endoscopic operation to open the sphenoid sinus,expose the tumor tissue,and then insert the neuroendoscope to remove the tumor tissue.The clinical symptoms,tumor resection rate,postoperative complications,operation time and blood loss were analyzed. Results The clinical symptoms of headache,visual field impairment and abnormal hormone levels were improved after operation in 64 patients.61 patients had tumor Simposon grade Ⅰ resection,3 patients had grade Ⅱ resection,and the total tumor resection rate was 95.31%.The average operation time was (65.35±15.65)min,the average intraoperative blood loss was (45±5.6)mL,which was significantly shorter than the previous simple microscope and simple neuroendoscopy,and the amount of bleeding was significantly reduced.There were 2 cases of cerebrospinal fluid rhinorrhea,1 case of temporary olfactory disturbance,4 cases of transient urinary collapse,and the overall incidence of postoperative complications was 10.93%.After drainage in the lumbar pool,nasal irrigation,and desmopressin acetate treatment.The postoperative complications disappeared.No complications such as tumor recurrence,delayed cerebrospinal fluid rhinorrhea,and abnormal hormone levels occurred during 3 6 months of follow up. Conclusion Modified neuroendoscopy combined with microsurgical transsphenoidal approach for the removal of pituitary adenomas is less intraoperative bleeding,short operation time and clinical efficacy.