内镜经鼻蝶入路垂体腺瘤切除术后并发症的诊治现状

Current status of diagnosis and management of postoperative complications after endoscopic endonasal transsphenoidal approach to pituitary adenoma removal

垂体腺瘤是颅内最常见的肿瘤之一,大多数可通过内镜鼻蝶手术良好切除。垂体腺瘤位于鞍内,可压迫垂体、视神经,侵袭蝶窦、海绵窦,向各个方向侵袭生长,同时又影响内分泌的功能。内镜经鼻蝶入路垂体腺瘤切除术(endoscopic endonasal transsphenoidal surgery,EETS)具有微创、可抵近观察、全景视图、肿瘤切除率高和正常垂体功能保存率高等优点,但可发生垂体内分泌、电解质紊乱,脑脊液漏,颅内感染,脑神经麻痹,瘤腔、颅内出血,鼻炎等相关并发症,影响患者的预后及生活质量。EETS术后并发症既与垂体腺瘤的病理生理特点相关,又与术者对垂体腺瘤病理、解剖的理解深度、手术技巧、熟练程度和临床经验密切相关。熟悉内镜下解剖及精细的手术技巧、丰富的手术经验、严格的术前内分泌功能评估、激素替代治疗等可降低EETS术后并发症的发生率。

Pituitary adenoma is one of the most common intracranial tumors,and most of them can be well removed by endoscopic transsphenoidal surgery.Pituitary adenoma is located in the sella,which can compress the pituitary and optic nerve,invade the sphenoid sinus and cavernous sinus,invade and grow in all directions,and affect the endocrine function at the same time.Endoscopic transsphenoidal pituitary adenoma resection(EETS)has the advantages of minimally invasive,close observation,panoramic view,high tumor resection rate and high preservation rate of normal pituitary function,but it can cause pituitary endocrine disorder,diabetes insipidus,electrolyte disorder,cerebrospinal fluid leakage,intracranial infection,cerebral nerve paralysis,tumor cavity,intracranial hemorrhage,rhinitis and other related complications.It affects the prognosis and quality of life of patients.The postoperative complications of EETS are not only related to the pathophysiological characteristics of pituitary adenoma,but also closely related to the depth of understanding of pathology and anatomy of pituitary adenoma,surgical skills,proficiency and clinical experience.Familiarity with endoscopic anatomy and fine surgical techniques,rich surgical experience,strict preoperative endocrine function evaluation,hormone replacement therapy,etc.can reduce the incidence of postoperative complications of EETS.