经鼻蝶窦入路垂体腺瘤切除术46例疗效观察

目的观察经鼻蝶窦入路手术治疗垂体腺瘤的效果。方法 46例垂体腺瘤患者均采用单鼻孔经鼻蝶窦入路显微镜下肿瘤切除术。结果肿瘤全切39例,次全切或大部分切除6例,未能切除1例。术后发生脑脊液漏3例,尿崩症19例,视力下降2例。结论经鼻蝶入路垂体腺瘤切除术是治疗垂体腺瘤安全有效的术式。术前准确评估病情、熟悉解剖和精湛的手术操作是手术成功的保证。     

单鼻孔经蝶入路与经颅入路手术切除垂体腺瘤疗效对比观察

目的对比观察单鼻孔经蝶（鼻蝶）入路与经颅入路手术切除垂体腺瘤的疗效,探讨垂体腺瘤的良好手术入路。方法48例患者分别采用经鼻蝶入路和经颅入路手术切除垂体腺瘤。结果与经颅入路手术者比较,经鼻蝶入路手术者手术时间短、出血量少、住院时间短、肿瘤全切除率高、激素改变明显、术后并发症发生率低（P均〈0．05）。结论经鼻蝶入路是垂体腺瘤切除的良好手术入路。     

内镜下经鼻蝶入路二次手术治疗复发垂体瘤245例

目的探讨内镜下经鼻蝶入路二次手术治疗复发垂体瘤患者的临床有效性及安全性,并总结手术操作技巧。方法选取2008-03~2014-02在兰州市第一人民医院脑外科住院的垂体瘤复发患者245例,患者初次垂体瘤手术方式为经蝶入路或开颅手术,后给予其二次内镜下经鼻蝶手术治疗,观察患者瘤体切除程度、术后视力及内分泌变化及并发症的发生情况,分析二次经蝶入路手术治疗垂体瘤的有效性及安全性。结果内镜下经鼻蝶入路二次手术治疗垂体瘤全切加次全切除率达80.38%,无严重并发症发生,无死亡病例。结论内镜下经鼻蝶入路二次手术治疗复发垂体瘤安全有效,值得临床推广应用。     

上颈段髓外肿瘤的诊断及手术治疗（附24例报告）

目的 探讨上颈段髓外肿瘤的术前诊断方法及手术入路.方法 对经手术治疗的24例上颈段髓外肿瘤患者的临床资料进行分析.结果 所有患者术前行MRI检查,确诊并明确肿瘤特点.均行手术治疗,其中采用枕后正中入路20例,肿瘤全切15例;采用远外侧入路4例,肿瘤全切3例.术后2例患者出现单纯性脑脊液漏,及时清创缝合后无颅内感染发生;1例高龄患者术后第16天死于肺感染导致的呼吸衰竭.结论 上颈段髓外肿瘤的术前诊断以MRI检查为首选,诊断明确后应积极手术治疗.枕后正中入路和远外侧入路是最常用的手术入路.     

显微镜下经鼻蝶入路垂体腺瘤切除术后并发症的影响因素

目的探讨显微镜下经鼻蝶入路垂体腺瘤切除术后并发症的影响因素。方法回顾该院103例垂体腺瘤患者,均采用显微镜下经鼻蝶入路垂体腺瘤切除术治疗,观察统计患者术后恢复及并发症发生情况。结果患者治疗总有效率为89.3%(92/103),随访3~24个月,无复发病例,术后并发症以尿崩症、术区出血、脑脊液鼻漏并发症为主,无死亡病例。经Logistic回归分析发现,患者术后并发症的发生与患者肿瘤大小、鞍旁侵袭、基础内分泌及手术切除程度具有显著相关性(β=0.92,1.02,1.03,1.21,P0.05)。结论显微镜下经鼻蝶入路垂体腺瘤切除术治疗垂体腺瘤疗效显著,术后并发症的发生与肿瘤大小、鞍旁侵袭、基础内分泌及手术切除情况密切相关,术前应全面认识影响并发症的相关因素,术中及时处理以减少术后并发症的发生。     

垂体脓肿的诊断及手术治疗（附7例报告）

目的探讨垂体脓肿的诊断和治疗方法。方法对7例垂体脓肿患者的临床资料作回顾性分析。结果本组视力视野障碍6例,头痛5例,泌乳、月经紊乱、性功能障碍、乏力、毛发脱落、多睡等3例,多饮多尿2例,发热1例。MRI示鞍区类圆形囊状占位性病变,等或长T1,长他,囊壁呈环形强化（“鸭梨”征）。本组均行颅内探查术,6例经鼻蝶入路,1例经右额开颅额下入路,术中肿块切开后均见脓液流出,切除脓肿并引流后患者症状改善,无复发。结论MRI检查有利于垂体脓肿的诊断;治疗原则为尽早手术切除病灶,充分冲洗引流,术后抗感染。     

内镜辅助下经鼻蝶入路手术治疗垂体瘤的临床效果观察

目的探讨内镜辅助下经鼻蝶入路手术治疗垂体瘤的临床效果。方法将该院2017-05～2018-05收治的92例垂体瘤患者,根据手术方法不同分为对照组和研究组,对照组行经鼻蝶显微镜垂体瘤切除术治疗,研究组行内镜辅助下经鼻蝶入路手术治疗。对比两组患者的临床疗效及两组患者内分泌激素水平及术后并发症发生情况。结果研究组的临床疗效优于对照组(P0.01),同时研究组的术后并发症总发生率显著低于对照组(P0.01);治疗后研究组血管紧张素、肾素、去甲肾上腺素等内分泌激素水平低于对照组(P0.01)。结论内镜辅助下经鼻蝶入路手术治疗垂体瘤患者的效果更佳,患者内分泌激素水平的影响相对较低,治疗有效率高,不良反应少,值得进一步推广。     

内镜下经鼻蝶入路手术治疗鞍区病变疗效观察

目的观察内镜下经单鼻孔蝶窦入路手术治疗鞍区病变的疗效。方法鞍区病变患者54例,均采用内镜下经单鼻孔蝶窦入路手术。其中垂体腺瘤47例,行肿瘤全切术39例、次全切除术6例、部分切除术2例;Rathke囊肿3例,均行全切除术;颅咽管瘤3例,行全切除术1例、次全切除术2例;垂体脓肿1例行病灶清除术。10例次全切除+部分切除者,术后均行放疗。结果本组无手术死亡病例。术后发生暂时性尿崩症12例、脑脊液鼻漏4例、鼻腔出血2例、颅内感染1例,经对症治疗均恢复。术后随访6～24个月,患者临床症状有不同程度改善,激素水平降至正常26例,较术前降低50.0%以上10例。术后随访无复发或瘤体增大。结论内镜下经单鼻孔蝶窦入路手术治疗鞍区病变创伤小、安全、肿瘤全切率高、并发症少、患者恢复快。     

内镜辅助下经鼻蝶入路治疗垂体瘤患者的疗效及对应激水平的影响

目的探讨内镜辅助下经鼻蝶入路治疗垂体瘤患者的疗效及对应激水平的影响。方法垂体瘤患者64例按照随机数字表法分为实验组和对照组,每组32例,实验组行内镜辅助下经鼻蝶入路进行垂体瘤切除术治疗,对照组行经鼻蝶显微镜垂体瘤切除术治疗,对比两组术中肾上腺素(E)、去甲肾上腺素(NE)、肾素(R)和血管紧张素(Ang)Ⅱ水平、手术相关指标、术后不良反应及治疗疗效。结果术中实验组E、NE、R和AngⅡ水平均显著低于对照组,手术时间、术中出血量和术后住院时间均显著少于对照组(均P<0.05)。实验组治疗总有效率高于对照组,术后不良反应总发生率低于对照组(均P<0.05)。结论内镜辅助下经鼻蝶窦入路垂体瘤切除术患者术中应激水平相对较低,不良反应发生率低,治疗有效率高,对临床神经外科手术治疗垂体瘤具有重要应用价值。     

全麻下神经内镜引导经鼻蝶入路切除术治疗垂体瘤的疗效观察

目的研究全麻下神经内镜引导经鼻蝶入路切除术治疗垂体瘤的疗效。方法选取2014年5月~2016年5月我院收治的垂体瘤患者88例作为研究对象,将其随机分为对照组与观察组,各44例。对照组给予经颅手术治疗,观察组给予全麻下神经内镜引导经鼻蝶入路切除术治疗,对两组疗效进行客观评定。结果治疗后,对照组优良率为79.55%,观察组优良率为97.73%;且观察组手术出血量比对照组组少,其住院时间也比对照组的短;观察组腺瘤切除率93.18%高于对照组的63.64%,差异均有统计学意义(P0.05)。结论在治疗垂体瘤患者中,选择全麻下神经内镜引导经鼻蝶入路切除术治疗,疗效显著,创伤性小、恢复快、安全性高,有助于提高患者生活质量,值得推广。     

经蝶入路显微外科治疗老年人垂体腺瘤

目的探讨老年人垂体腺瘤（ＳＰＡ）的手术疗效。方法总结经ＣＴ扫描或ＭＲＩ确诊的５６例ＳＰＡ经蝶显微外科治疗的临床资料，３５例经唇下－鼻中隔－蝶窦入路、２１例经鼻前庭－鼻中隔－蝶窦入路行肿瘤切除术。结果本组微腺瘤７例，大腺瘤３０例，巨大腺瘤１９例，术后无死亡。４８例获长期随访（平均３．５年），４１例恢复良好；７例术后平均３．４年肿瘤复发，其中２例再次手术，５例采用药物、放疗或放射外科治疗，于３个月时复查见患者恢复较为满意。结论采取经蝶显微外科治疗ＳＰＡ，是一种安全、有较的方法     

Primary granulomatous hypophysitis: a case report and literature review

Primary granulomatous hypophysitis (PGH) is a rarely occurred inflammatory disease of unknown etiology. We retrospective review a case of PGH treated by microsurgical transsphenoidal approach and review the appropriately documented cases of PGH collected from the literatures. The patient was a 56-year-old female who presented with 4 months history of headache and 2 months history of polyuria and polydipsia. Clinic examination did not find remarkable neurological signs, except endocrinological abnormalities of secondary hypothyroidism and hypocorticalism. MRI revealed a symmetric sellar mass, which was isointensity as gray matter on T1-weighted and T2-weighted images with heterogeneous enhancement. The mass was partially resected via transsphenoidal approach. Histological assessment revealed a non-necrotizing granulomatous lesion with chronic inflammation. Although the resection was limited, repeatedly MRI scanning in 3 months following surgery revealed almost normal pituitary soft tissue without evidence of the lesion. Searching in PubMed, we found 21 papers published from 1985 to 2009 and 37 patients with PGH were reported. In order to identify the clinical and radiological presentation, treatment strategy, and prognosis of PGH, we analyzed these 38 cases together. The results indicate that the clinical presentations and radiological signs are helpful for the diagnosis of PGH. The outcome of surgery for PGH is favorable for immediate mass reduction and histological diagnosis, but hormone replacement is required in most cases and long-term follow up is very important.     

Pituitary abscess: a report of two cases

Pituitary abscess (PA) is an infrequent disease, which consists of an infection within the sella turcica that might be life-threatening. We present here two cases of this rare entity. Case 1: A 53-year-old woman was followed for an incidentally found pituitary cyst. Six years later the cyst enlarged and transsphenoidal surgery was performed. Two years later, the patient developed sudden onset of intense headache and nausea. The MRI showed a 2 by 2.5 cm sellar and suprasellar mass, that enhanced peripherally with gadolinium contrast and became hyperintense in T2-weighted images, suggesting a new-onset cystic lesion. During transsphenoidal surgery, large amounts of purulent material were drained from the sella. The cultures were positive for Klebsiella Ozaenae. Case 2: A 63-year-old woman, 4 years after transsphenoidal resection of a GH-secreting macroadenoma, developed a new sellar 2.6 cm cystic mass. On re-operation, purulent material was drained from the sella. The lesion persisted on the MRI and visual acuity worsened so a repeat pituitary decompression was carried out 6 months later, obtaining the same pathological results. Three years later, the MRI still shows the same mass. She feels well and her physical examination and clinical history are unremarkable. These cases illustrate the difficulties in the diagnosis and management of this rare entity.     

原发性胃肠道恶性淋巴瘤33例临床分析

目的探讨原发性胃肠道恶性淋巴瘤的早期诊断及治疗。方法回顾分析1997—2005年33例原发性胃肠道恶性淋巴瘤（PGIML）患者的临床资料。结果内镜及活检确诊率为44．4％。免疫分型以B细胞为主（90．9％）。全组患者有30例经手术治疗，2例仅行Hp根除术，1例确诊后放弃治疗。术后：单纯手术者21例，2年及以上生存者19例（90．5％）；手术加化疗者9例，2年及以上生存者6例（66．7％）。在11例胃黏膜相关淋巴组织（MALT）淋巴瘤中有2例胃MALT淋巴瘤行抗Hp治疗，肿瘤消退或缩小；9例行手术切除，术后未复发。结论PGIML早期诊断较困难，可采取多种诊断手段综合诊断，手术治疗作用尚未肯定，还需进一步随访观察。     

延-颈髓交界区硬脊膜动静脉瘘六例的诊治

目的探讨延．颈髓交界区硬脊膜动静脉瘘的临床特点、诊断和外科治疗。方法对6例经脊髓MRI及DSA检查确诊的延．颈髓交界区硬脊膜动静脉瘘患者，行经枕下后正中入路，电凝阻断瘘口显微外科手术治疗，其中1例先行血管内瘘口栓塞，后行手术治疗，术后随访2个月至10年。结果术后椎动脉造影复查显示瘘口及粗大的引流静脉影消失。3例患者症状逐渐缓解，双下肢肌力恢复至Ⅳ级，大小便能够自控，未见复发；2例患者症状无改善；1例患者死于术后肺部感染。结论显微外科手术直视下切除延-颈髓交界区硬脊膜动静脉瘘口，疗效较栓塞治疗更为确切。早期诊断并及时消除引起静脉高压的始动因素，保证脊髓静脉引流的通畅，是获得较好疗效的关键。     

Complete surgical resolution of bilateral total opthalmoplegia without visual field defect in an acromegalic patient presented with pituitary apoplexy

Pituitary apoplexy (PA), which is one of the most serious life-threatening complications of pituitary adenoma, is characterized by abrupt onset of headache, nausea, vomiting, visual disturbances and oculomotor paresis. Combination of oculomotor cranial nerve paralysis with normal visual fields is very rare in PA. We report a 60-year-old acromegalic man presented with panhypopituitarism and bilateral total opthalmoplegia without a visual field defect. At initial evaluation his clinical findings were compatible with adrenal crisis and eye examination revealed total opthalmoplegia, bilateral ptosis and normal vision. MRI showed a large heterogeneous mass in the pituitary fossa. Although clinical findings due to adrenal crisis improved after glucocorticoid therapy there was no improvement in opthalmoplegia and ptosis. The patient underwent transsphenoidal excision of the pituitary mass. Histological examination revealed an adenoma with large areas of hemorrhagic infarction and most of the cells were positive for GH in immunohistochemical analysis. Although opthalmoplegia was severe at presentation, total recovery was achieved 3 months after transsphenoidal surgery. Therefore the presented case clearly demonstrates that opthalmoplegia without a visual field defect due to PA has a good prognosis and early diagnosis and treatment including surgical decompression are crucially important.     

肝病患者TBA、PA、Cys C、GLDH、CHE检测分析

目的探讨血清前白蛋白（PA）、总胆汁酸（TBA）、谷氨酸脱氢酶（GLDH）、半胱氨酸蛋白酶抑制剂C（CysC）和胆碱酯酶（CHE）联合检测在肝病患者中的变化和临床意义,为其诊断和治疗提供依据。方法 253例肝病患者分为急性肝炎（84例）、慢性肝炎（93例）、肝硬化（46例）、肝癌（30例）4组;56例健康体检者作为对照组,分别检测血清TBA、PA、CHE、GLDH、CysC浓度并进行对照分析。结果肝病患者各组患者PA、CHE浓度明显降低,以肝硬化和肝癌组最为明显;CysC、GLDH、TBA显著升高,依次为肝硬化组、慢性肝炎组、急性肝炎组,与对照组相比,差异均有统计学意义（P〈0.05）。结论 PA、CHE变化反映各型肝炎早期肝细胞的损害程度。TBA、CysC、GLDH是各种肝病的敏感指标,对肝炎的早期诊断及预后判断有重要临床意义。     

Long-term follow-up of hypothalamic-pituitary function in patients with transsphenoidal pituitary herniation and midfacial anomalies.

OBJECTIVE: We wished to determine whether patients with transsphenoidal pituitary herniation were at risk of developing pituitary failure. DESIGN: We followed up hypothalamic-pituitary function annually in patients with midfacial anomalies and pituitary herniation. PATIENTS: Two patients who had transsphenoidal pituitary herniation and midfacial anomalies were included and the literature was reviewed. RESULTS: Both patients became gonadotrophin, TSH and growth hormone-deficient despite neurosurgical repair. CONCLUSION: We conclude that the early diagnosis and neurosurgical repair of transsphenoidal pituitary herniation may prevent central nervous system infection and rhinorrhoea. Surgical repair may not prevent pituitary failure as was evident in both of our cases. Periodic evaluation of the hypothalamic-pituitary axis is essential to determine whether early hormonal replacement therapy is necessary.     

肺癌肉瘤的临床分析

目的提高肺癌肉瘤的诊治水平。方法通过２例经手术及病理证实的肺癌肉瘤的病例分析，结合文献复习，对肺癌肉瘤的组织发生，病理，临床特征，诊断，治疗以及与原发性肺癌的鉴别诊断进行了讨论。结果肺癌肉瘤是一种罕见的即含有癌又含有肉瘤两种成分的复合性肿瘤。临床上分为浸润型（周围型）和支气管管内型（中心型）两种。前者肿块位于边缘，生长迅速，早期发生转移；后者肿块位于肺门部，生长缓慢，转移晚。结论肺癌肉瘤常易误诊，预后差。首选治疗为手术切除。     

医源性结肠穿孔原因分析及处理措施

目的探讨结肠镜检查及治疗时发生肠穿孔的原因及对其早期诊断和治疗的方法。 方法回顾性分析2013年1月至2017年12月经宁夏人民医院总院和分院行结肠镜检查或治疗的25 426例患者的临床资料,记录发生肠穿孔患者的年龄、性别、临床诊断、穿孔部位、穿孔原因及穿孔后的治疗方法。 结果共有6例发生肠穿孔,其中,5例为即刻穿孔、1例为迟发性穿孔。6例患者中,3例为结肠息肉钳除术患者,内镜下用钛夹封闭穿孔,经保守治疗后出院;另外2例结肠肿瘤溃疡、1例溃疡性结肠炎患者经外科治疗后好转出院。 结论结肠穿孔是结肠镜诊疗时并不常见的并发症;术前应充分了解患者的临床资料,严格掌握适应证及禁忌证,操作时动作轻柔,可最大程度地减少或避免此类并发症的发生。