内镜下扩大经鼻入路手术切除鞍上侵袭性垂体腺瘤

Extended endoscopic endonasal approach in resection of suprasellar invasive pituitary adenoma

目的分析内镜下扩大经鼻入路手术切除鞍上侵袭性垂体腺瘤的疗效及安全性。方法与结果以2019年6月至2022年6月河北医科大学第二医院收治的68例鞍上侵袭性垂体腺瘤患者为研究对象,于内镜下扩大经鼻入路手术切除肿瘤,73.53%(50/68)实现全切除,17.65%(12/68)次全切除,8.82%(6/68)部分切除;巨大型腺瘤全切除率达37.40%(10/27)。平均随访(12±6)个月,视力改善者占75.81%(47/62)、无变化19.35%(12/62)、恶化4.84%(3/62);视野缺损改善占74.14%(43/58)、无变化15.52%(9/58)、加重10.34%(6/58);动眼神经麻痹患者末次随访复视消失(3例)。术后并发症包括脑脊液漏[1.47%(1/68)]、中枢性尿崩症[16.18%(11/68)]、术区血肿[4.41%(3/68)]、迟发性鼻腔出血[4.41%(3/68)]和颅内感染[7.35%(5/68)],无死亡病例。结论于内镜下扩大经鼻入路手术切除向前颅底、鞍上区域、第三脑室方向侵袭的大型或巨大型垂体腺瘤,全切除率高、创伤小、并发症少,值得临床推广。

Objective To analyze the clinical efficacy and safety of the extended endoscopic endonasal approach(EEEA)in the resection of suprasellar invasive pituitary adenoma.Methods and Results A total of 68 patients with suprasellar invasive pituitary adenoma admitted to The Second Hospital of Hebei Medical University from June 2019 to June 2022 were treated with EEEA for tumor resection,of whom 73.53%(50/68)achieved gross total resection(GTR),17.65%(12/68)achieved subtotal resection,and 8.82%(6/68)achieved partial resection.The GTR rate of giant adenoma was 37.40%(10/27).The average follow⁃up was(12±6)months,75.81%(47/62)improved visual acuity,19.35%(12/62)had no change after surgery,4.84%(3/62)deteriorated visual acuity.The improvement rate of visual field defect was 74.14%(43/58),no change was 15.52%(9/58),and symptom aggravation was 10.34%(6/58).The symptoms of diplopia disappeared completely in the patients with oculomotor nerve palsy at the last follow⁃up(3 cases).Postoperative complications included cerebrospinal fluid leakage[1.47%(1/68)],central diabetes insipidus[16.18%(1/68)],intraoperative hematoma[4.41%(3/68)],delayed nasal hemorrhage[4.41%(3/68)]and intracranial infection[7.35%(5/68)],with no death.Conclusions EEEA for large or giant pituitary adenomas invading the anterior skull base,suprasellar region and the third ventricle has a high GTR rate,less trauma and fewer complications,and is worthy of clinical promotion.