神经内镜经双鼻孔入路切除侵袭性垂体腺瘤的临床疗效分析

Clinical analysis on neuroendoscopic resection of invasive pituitary adenoma through bilateral nostril approach

目的探讨神经内镜下经双鼻孔入路切除侵袭性垂体腺瘤的临床疗效及安全性。方法回顾性分析38例经双鼻孔蝶窦入路内镜下切除侵袭性垂体腺瘤患者的临床资料;总结分析其临床疗效、并发症和优势。按Knosp分级,Ⅲ级者28例、Ⅳ级者10例。结果本组患者中肿瘤全切除者18例、次全切除者12例、部分切除者8例。术后视力视野改善者22例,有效率为81.5%(22/27例);头痛缓解者11例,有效率为78.6%(11/14);内分泌功能障碍缓解9例,有效率为81.8%(9/11)。术后并发尿崩症者17例(44.7%)、脑脊液鼻漏1例(2.6%)、颅内感染1例(2.6%),行鞍区血肿清除术1例,无死亡病例。10例患者术后行放疗,2例患者行药物治疗。结论经双鼻孔入路内镜下切除侵袭性垂体腺瘤的肿瘤切除率高、创伤小、并发症发生率低,同时提高了手术的安全性和有效性。

Objective To explore the safety and effectiveness of neuroendoscopic resection of invasive pituitary adenoma through bilateral nostril approach.Methods The clinical data of 38 patients with invasive pituitary adenoma treated by neuroendoscopic bilateral nostril transsphenoidal approach were analyzed retrospectively.The clinical efficacy and complications were analyzed and summarized,and the advantages of this method were discussed.According to knosp classification,28 cases were gradeⅢand 10 cases were gradeⅣ.Results Total resection was performed in 18 cases,subtotal resection in 12 cases and partial resection in 8 cases.Postoperative visual acuity was improved in 22 cases,the effective rate was 81.5%(22/27 cases),headache was relieved in 11 cases,the effective rate was 78.6%(11/14),and hormone level was relieved in 9 cases,the effective rate was 81.8%(9/11).Complications included diabetes insipidus in 17 cases(44.7%),cerebrospinal fluid rhinorrhea in 1 case(2.6%),intracranial infection in 1 case(2.6%),and removal of hematoma in sellar region in 1 case.Postoperative radiotherapy was performed in 10 cases and drug therapy in 2 cases.Conclusion Transnasal endoscopic resection of invasive pituitary adenomas has the advantages of less traumatic,lower incidence of complications,shorter operation time,higher tumor resection rate,and improves the safety and effectiveness of the operation.