鞍底开窗对显微镜下经蝶入路垂体腺瘤切除术的影响

Influence of the sellar floor fenestration on the endonasal transsphenoidal surgery for pituitary adenoma under the microscope.

目的探讨鞍底开窗对显微镜下经蝶入路垂体腺瘤切除术的影响。方法收集本院2014年3月至2015年3月收治的经鼻蝶入路手术患者51例的临床资料,进行回顾性研究。其中男性22例,女性29例,年龄19~75岁。手术前后均行CT、MRI检查,通过Mimics15.0软件进行影像融合重建,测算鞍底骨窗的大小、最高点到蝶骨平台的垂直距离,分析其与肿瘤切除程度、术中脑脊液漏及术后尿崩症发生的关系。结果肿瘤全切除组的鞍底骨窗面积小于残留组,其骨窗面积与肿瘤最大面积的比值大于残留组;术中脑脊液漏组其骨窗最高点到蝶骨平台的垂直距离小于无脑脊液漏组。差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,鞍底骨窗与肿瘤面积的比值、肿瘤的侵袭性,是影响垂体腺瘤切除程度的独立预测因素。有尿崩症组与无尿崩症组,其鞍底骨窗面积无统计学差异(P>0.05)。结论鞍底开窗相对不足,是导致肿瘤残留的原因之一;骨窗的位置越高,术中越易出现脑脊液漏;鞍底开窗面积对术后尿崩症的发生无明显影响。

Objective To explore the influence of the sellar floor fenestration on the microscopic endonasal transsphenoidal surgery for pituitary adenoma.Methods 51 patients(including 22 cases of male and 29 cases of female,aged from 19 to 75)of pituitary adenoma patients who undergone microscopic endonasal transsphenoidal surgery at the 900th Hospital of the Joint Logistics Team from March 2014 to March 2015 were included in this retrospective analysis.Paranasal sinus CT and pituitary MRI scan were done for each patient before and after operation.Image fusion and reconstruction were done by Mimics 15.0 software.The area of sellar floor fenestration and the vertical distance from the highest point of fenestration to planum sphenoidale were observed and measured.The relationships between them and the extent of tumor resection,intraoperative cerebrospinal fluid leakage,postoperative diabetes insipidus were analyzed retrospectively.Results The area of sellar floor fenestration in the total removal group was smaller than that of the incomplete resection group,while the ratio of sellar floor fenestration area to the largest tumor area in the total removal group was larger than that of the incomplete resection group.The vertical distance from the highest point of fenestration to planum sphenoidale in the intraoperative cerebrospinal fluid leakage group was shorter than that of the without intraoperative cerebrospinal fluid leakage group.The difference among of them was statistically significant(P<0.05).Logistic regression analysis showed that the ratio of sellar floor fenestration area to the largest tumor area and tumor invasion were independent predictive factors that influenced the extent of pituitary adenoma resection(P<0.05).in There were no statistical difference on the area of sellar floor fenestration between the diabetes insipidus group and without diabetes insipidus group(P>0.05).Conclusions The relative insufficient of the sellar floor fenestration is one of the most important reasons for residual tumor.The higher position of the sellar floor fenestration,the more possible leakage of cerebrospinal fluid.The occurrence of postoperative diabetes insipidus were not associated with the size area of sellar floor fenestration.