神经内镜下经单鼻孔-蝶窦摘除垂体腺瘤(附127例报告)

Endonasal transsphenoidal surgery under neuroendoscope for large pituitary adenoma: report of 127 cases

目的总结神经内镜下经单鼻孔-蝶窦路径摘除大型垂体腺瘤(LPA)的手术技术,并评价其疗效。方法回顾性分析127例LPA经蝶内镜手术经验。术前影像学检查示肿瘤均压迫视神经与视交叉。结果肿瘤全切除114例(89.8%),次全切除9例(7.1%),4例(3.1%)纤维性肿瘤仅获部分切除。术后死亡1例。110例获得平均3个月的随访,视力迅速恢复101例(91.8%),余9例(8.2%)好转;术前视野缺损107例,术后100例(93.5%)恢复,另7例(6.5%)改善。结论神经内镜下经单鼻孔-蝶窦路径切除LPA是一种有效的微侵袭手术方法。

Objective To review the surgical techniques and evaluate the therapeutic effect of endonasal transsphenoidal approach for neuroendoscopic removal of large pituitary adenoma(LPA).Methods The experience with endoscopic endonasal transsphenoidal surgery was retrospectively reviewed in 127 cases of LPA,in which preoperative CT or MRI showed sellar masses causing optic nerve and optic chiasmal compressions.Results Total removal was achieved in 114 cases(89.8%),subtotal in 9(7.1%),and partial removal in 4(3.1%) with fibrous tumor.Postoperative death occurred in one case.Follow-up study for a median of 3 months in 110 patients revealed rapid improvement visual acuity in 101 patients(91.8%) with visual acuity impairment due to optic nerve compression and moderate improvement in 9 patients(8.2%).Among the 107 patients with preoperative visual field defects,postoperative recovery was achieved in 100 patients(93.5%) and improvement in 7(6.5%).Conclusion The endonasal approach with the neuroendoscope can be an effective minimally invasive method for LPA removal.