假包膜外切除技术在生长激素型垂体腺瘤中的应用

Extra-pseudocapsular Dissection Technique for Growth Hormone-type Pituitary Adenomas

目的探讨假包膜外切除技术在神经内镜下经鼻蝶手术治疗生长激素型垂体腺瘤中的应用价值。方法我院2014年1月~2019年4月神经内镜下采用假包膜外切除生长激素型垂体腺瘤55例,在正常垂体或垂体包膜和假包膜之间沿假包膜外界面钝性分离,将假包膜与腺瘤一并切除。结果手术时间60~200 min,(80.5±11.5)min;术中出血量5~400 ml,(100±20)ml。术中发现术区脑脊液漏14例,术后发生脑脊液鼻漏2例,暂时性尿崩13例,永久性尿崩1例,颅内感染9例,鼻腔出血3例,采取相应干预措施后均治愈。术后住院2~14 d,(5.5±1.5)d。术后病理诊断均为GH型垂体腺瘤。55例随访6~55个月,平均22.5月:肿瘤全切除率89.1%(49/55),生化治愈率87.3%(48/55);肿瘤复发12例,复发时间为术后(10.6±3.2)月,其中7例接受神经内镜下再次手术治疗,2例接受醋酸奥曲肽微球药物治疗,2例接受伽马刀治疗,1例接受放射治疗,复发肿瘤均得到控制并在密切随访中。结论神经内镜下采用假包膜外切除技术有助于提高GH型垂体腺瘤全切除率和术后生化治愈率,值得临床上推广。

Objective To evaluate the value of extra-pseudocapsular dissection technique in neuroendoscopic transsphenoidal surgery for growth hormone-type pituitary adenomas.Methods A retrospective analysis was performed on 55 patients with growth hormone pituitary adenoma treated by neuroendoscopy with extra-pseudocapsular from January 2014 to April 2019.Blunt separation along the outer interface of the pseudocapsule between the normal pituitary or pituitary capsule and the pseudocapsule was performed to remove the adenoma with pseudocapsule.Results The operation time was 60-200 min[mean,(80.5±11.5)min].The intraoperative blood loss was 5-400 ml[mean,(100±20)ml].There were 14 cases of cerebrospinal fluid leak during surgery,2 cases of cerebrospinal fluid leak after surgery,13 cases of transient diabetes insipidus,1 case of permanent diabetes insipidus,9 cases of intracranial infection,and 3 cases of nasal hemorrhage,all of which were cured after taking corresponding intervention measures.The postoperative hospitalization was 2-14 days[mean,(5.5±1.5)days].Postoperative pathological diagnosis was GH type pituitary adenoma.All the 55 cases were followed up for 6-55 months(mean,22.5 months).The total tumor resection rate was 89.1%(49/55)and the biochemical cure rate was 87.3%(48/55).There were 12 cases of recurrence during(10.6±3.2)months after operation.Among them,7 cases received neuroendoscopic reoperation,2 cases received octreotide acetate microsphere therapy,2 cases received gamma knife therapy,and 1 case received radiotherapy.All recurrent tumors were controlled and were under close follow-ups.Conclusion Extra-pseudocapsular dissection is a mature surgical technique,which is worthy of popularizing clinically.