经蝶窦入路垂体腺瘤手术并发症分析

目的 分析单鼻孔蝶窦入路并结合神经内镜切除垂体腺瘤的手术并发症.方法 回顾性分析经蝶窦切除垂体腺瘤323例患者的术后并发症.结果 本组尿崩症病例发生率为52%,脑脊液漏19例(6%),迟发2例,2例行手术修补.颅内感染发生率3%(11例),其中1例因感染反复发作死亡.垂体功能低下8例,有2例患者因为感染和饮食不佳出现垂体危象,视力减退发生率2%(6例).结论 熟悉手术局部解剖,把握手术适应证,熟练掌握手术技能、不断总结临床实践经验,才能降低手术并发症和病死率,提高治疗效果.

Abstract：

Objective To analyze the complications of transsphenoidal operation for pituitary adenomas.Method Postoperative complications of 323 patients underwent transphenoidal surgery for pituitary adenoma between January 2001 and December 2009 in our department were retrospectively reviewed.Results Insipidus was the most common complication after the operation with the incidence of 52％.The other complications were visual deterioration( 2％), cerebrospinal fluid rhinorrhea( 6％),intracranial infection ( 3％), pituitary insufficiency( 2.4％), pituitary articulo ( 0.6％).Conclusions Better understanding of the indications for transsphenoidal surgery and familiarity with the regional anatomy should further lower the rates of death and complications.Skill surgical technique and clinical experience are also very important to improve the therapeutic efficacy.     

神经内镜下经鼻蝶窦垂体腺瘤切除术并发症的防治

目的 探讨神经内镜下经单鼻孔蝶窦切除垂体腺瘤的并发症的防治.方法 对在神经内镜下经单鼻孔蝶窦切除垂体腺瘤253例临床资料分析.结果 肿瘤全切除216例(85.38%),次全切除26例(10.28%),部分切除11例(4.34%),无手术死亡病例.术后并发暂时性尿崩45例,术后垂体功能低下9例,脑脊液鼻漏2例,鼻腔黏膜出血2例,嗅觉丧失2例,无发生颈内动脉、视神经损伤,无蛛网膜下腔出血、颅内和局部感染,无鼻中隔穿孔.结论 神经内镜下经单鼻孔蝶窦垂体腺瘤切除术手术创伤小,术前做好评估,术中精细操作,术后并发症可减至最小,是一种安全、有效的治疗方法.

Abstract：

Objective To discuss the complicatiaons's prophylaxis of removing pituitary adenomas of neuroendoscopy in tranasphenoidal surgery. Method To analayze 253 cases Clinically date of pituitary adenoma were treated by endoscopic endonasal transsphenoidal surgery. Results The tumor removal was total in 216 ( 85.38% ) cases, subtotal in 26 ( 10. 28% ), and partial in 11 ( 4. 34% ). Temporary diabetes insipidus in 45 cases, pituitary function subnomorlity in 9 cases, cerebrospinal fluid leaks in 2 cases, nostril stenoses in 2 cases, anodmia in 2 cases, there were no internal carotid artery and optic nerve lesion, no subarachnoid hemorrhage and intracranial infection, no nasoseptal tresis. Conclusions Featured by minimal invasion and less postoperative complications, neurendoscopic endonasal transsphenoidal surgery is a safe and effective method for the treatment of pituitary adenoma.     

蝶窦内间隔与经单鼻孔-蝶窦-鞍区肿瘤切除术效果分析

目的 对蝶窦内间隔特点及经蝶窦-鞍区肿瘤手术的关系进行探讨.方法 分析北京军区总医院附属八一脑科医院自2008年1月至2010年12月收治的107例经单鼻孔-蝶窦-鞍区肿瘤切除术患者的术前蝶窦内间隔资料,并用以指导术中操作.结果 本组肿瘤全部切除67例(62.6%),大部切除21例(19.6%),部分切除19例(17.8%).其中47例根据蝶窦间隔的指示,迅速确定肿瘤所在鞍底位置,或保留无关间隔,并根据间隔确认颈内动脉位置,避免损伤;11例存在复杂蝶窦内间隔者,根据影像学提示得以快速判定鞍底与间隔的关系并确定蝶窦内骨质切除范围与方向,顺利完成手术.手术相关并发症:左侧颈内动脉破裂1例,海绵窦破损4例.结论 术前仔细判读蝶窦内间隔影像学资料,用以指导经蝶窦-鞍区肿瘤手术操作,可以预防和减少并发症.

Abstract：

Objective To study the relationship of sphenoidal intersinus septa with transsphenoidal resection of sellar area tumor. Methods The pre-operative MRI and CT images of the sphenoid intersinus septa and its importance in transsphenoidal resection of sellar area tumor were studied in 107 patients, admitted to our hospital from January 2008 to December 2010. The amounts, locations, anatomic specialties of the septa and its relationships with the floor of selle, the internal carotid artery canals and the tumors were analyzed to guide the operative procedures during the operation. Results Total removal of the tumors in seller region was obtained in 67 patients, subtotal removal in 21 and partial removal in 19. According to the MRI and CT images of the sphenoid intersinus septa, the location of the tumor and the carotid artery in 47 patients were quickly determined; complex sphenoid intersinus septa was noted in 11 patients, and the relation of sellar floor with the septa was quickly determined and the scope and direction of removal were determined too. Rupture of the internal carotid artery occurred in 1 patient, and damages of the cavernous sinuses occurred in 4. Conclusion Careful study of the pre-operative MRI or CT images of the sphenoidal intersinus septa and its relationship with the floor of seller, the internal carotid artery and the tumor will assure the transspenoidal surgery more precisely and safely, and the complication can be efficiently prevented and decreased.     

经蝶窦垂体腺瘤手术中发生脑脊液漏的原因和防治

目的 探讨经蝶窦入路垂体腺瘤手术中发生脑脊液漏的常见原因及其防治方法.方法 回顾性分析260例显微镜下、274例神经内镜下经蝶窦垂体腺瘤切除术中,46例术中发生脑脊液漏,其中显微镜手术24例,神经内镜手术22例.术中多用人工干燥硬脑膜或自体脂肪及纤维蛋白胶修补,蝶窦内填明胶海绵,对于肿瘤体积巨大,鞍底骨质广泛破坏甚至消失者,用骨片填放于蝶窦内固定填塞的软组织.根据术中修补情况36例术后即刻行腰大池置管持续引流.结果 术中修补46例脑脊液漏,术后13例发生脑脊液漏,经腰大池引流3-6 d愈合;6例发生细菌性脑膜炎,经腰大池引流治愈.结论 术前应充分估计容易发生脑脊液漏的患者,手术操作格外小心,并准备好修补措施;应用自体脂肪及纤维蛋白胶修补经蝶窦垂体腺瘤术中脑脊液漏是有效的方法;如果术后发生脑脊液漏或细菌性脑膜炎,则需要腰大池置管持续引流.

Abstract：

Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery.Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed.CSF leak occurred in 24 cases with microscopic surgery and in 22 cases with endoscopic surgery during operation.The sellar floors were sealed by artificial dried dura or free autogenic fat and fibrin glue for the CSF leakage during surgery.For giant tumors which extensively destroyed sella floor,we put bony plates in sphenoid sinus to support the crammed tissue.Lumber drainage was performed immediately after operation in 36 cases.Methods In the 46 patients with CSF leakage during surgery,13 cases occurred CSF leakage postoperatively,cured in 3-6 days after lumber drainage.6 patients occurred bacterial meningitis,cured after long term lumber drainage.Conclusion Probability of CSF leak before transsphenoidal surgery should be estimated,and preparation for the fixing up the leak is necessary.Using free autogenic fat and ebonite to repaired the sellar floors in case of CSF leakage during surgery is a effective measurement.Patients with CSF leakage or bacterial meningitis after surgery require lumber drainage.     

虚拟内镜技术在内镜经鼻蝶入路垂体瘤切除术中的运用

目的 运用虚拟内镜(VE)技术观察内镜经鼻蝶入路的解剖结构,探讨其对内镜经鼻蝶入路垂体瘤切除术的指导价值. 方法 南方医科大学珠江医院神经外科自2007年12月至2010年3月行内镜经鼻蝶入路垂体瘤切除术患者21例,患者术前均采用64排CT扫描及VE图像重建.比较术前VE和术中内镜图像并分析经鼻蝶入路中解剖结构累加分值的相关性. 结果 术前VE图像与术中神经内镜图像非常相似;解剖结构的相符性良好,术前VE和术中内镜下8个解剖结构显示的累加分值具有正相关关系(r=0.923,P=0.001);调整VE的位置可以模拟神经内镜经鼻蝶入路垂体瘤切除术,观察内镜下经鼻蝶入路的解剖结构. 结论 VE能于术前准确直观地显示内镜经鼻蝶入路的重要解剖结构及变异,指导术前计划形成,提高手术效率,增加手术操作的安全性.

Abstract：

Objective To observe the anatomical structure via endonasal transsphenoidal approach with virtual endoscopy (VE) and explore the clinical applications of VE in endoscopic pituitary tumor resection through the endonasal transsphenoidal approach. Methods The VE was applied to the reconstruction of the pre-surgical 64-slice CT scanning of the 21 patients with pituitary adenoma received the endoscopic endonasal transsphenoidal surgery. A comparative study and a correlation analysis of cumulative scores of the anatomical structure were performed between the reconstructed VE images and the intraoperative endoscopic ones. Results Preoperative VE images and intraoperative endoscope images are very similar. The correlation of cumulative scores of the anatomical structure between the VE images of anatomical findings and the intraoperative images was positively noted (r=0.923, P=0.001),indicating that VE can be applied to simulately observe the anatomical structure before the endoscopic endonasal transsphenoidal pituitary surgery, and observe the anatomical structure through the endonasal transsphenoidal approach. Conclusion Being able to display the important anatomical structure and its varieties before the endoscopic endonasal transsphenoidal pituitary surgery, VE proves to be a valuable approach to the preoperative planning, increases the surgical efficiency and improves the safety of the surgery.     

大型听神经瘤常见并发症及其防治

目的 探讨神经电生理监测下经枕下乙状窦后入路切除大型听神经瘤的常见并发症及其防治措施.方法 安徽医科大学附属省立医院神经外科自2006年5月至2010年4月在神经电生理监测下采用枕下乙状窦后入路手术切除大型听神经瘤116例,回顾性分析患者的临床资料和随访结果,比较肿瘤大小对患者术后近期、远期并发症发生率的影响.结果 本组肿瘤全切除107例,次全切除7例,大部切除2例;术中面神经解剖保留101例(87.07%),术后1周根据House-Brackman面神经功能分级标准对患者面神经功能进行评估显示Ⅰ、Ⅱ级89例(76.72%),Ⅲ、Ⅳ级13例(11.21%),Ⅴ、Ⅵ级14例(12.07%).患者出院后随访3～12个月,近期并发症主要为-过性声嘶、饮水呛咳(16例)和患侧单纯性疱疹(20例);远期并发症主要为听力丧失(83例)、永久性面瘫(23例);肿瘤直径>5 cm患者近期并发症中声嘶、饮水呛咳和患侧单纯性疱疹发生率较直径3～5 cm患者高,差异有统计学意义(P<0.05).结论 熟悉手术入路相关临床解剖、积累手术经验、肿瘤大小、术中神经电生理监测是减少手术并发症的关键因素.

Abstract：

Objective To discuss the common complications of large acoustic neuromas performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring, and the prevention of postsurgical complications. Methods One hundred and sixteen patients with large acoustic neuromas, admitted to our hospital from May 2006 to April 2010, were performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring; clinical data and follow-up data (3-12 months) of these patients were collected and analyzed retrospectively; the influence of tumor dimension on short- and long-term postoperative complications after the surgery were compared.Results Total tumor resection was achieved in 107 patients, subtotal resection in 7 patients, and partial resection in 2 patients. After the operation, the facial nerve was preserved anatomically in 101 patients (87.07%); and the functional valuation of facial nerve according to postoperative House-Brackman showed 89 patients (76.72%) in grade Ⅰ-Ⅱ, 13 patients (11.21%) in gradeⅢ-Ⅳ and 14 patients (12.07%) in grade Ⅴ-Ⅵ. Short-term postoperative complications included hoarse voice in 16 patients and herpes catarrhalis of injured side in 20 patients. Long-term postoperative complications included loss of hearing (n=83) and permanent facial paralysis (n=23). Patients with tumor dimension larger than 5 cm had a significantly higher incidence of short-term postoperative complications than those within 3-5 cm (P< 0.05). No patient died. Conclusion The keys to avoiding the complications are to master the clinical anatomy of the approach, accumulate surgical experiences, preoperatively study the individual imaging and clinical data, and use intraoperative nerve monitoring.     

导航引导下内镜扩大经鼻蝶窦入路切除鞍上区和第三脑室内颅咽管瘤

目的 探讨导航引导下完全内镜扩大经鼻蝶窦入路切除位于鞍上区和第三脑室内颅咽管瘤的可行性和有效性.方法 采用内镜扩大经鼻蝶窦入路、术中导航引导下切除3例位于鞍上区和第三脑室内的颅咽管瘤.结果 3例颅咽管瘤全切,手术效果好.术后随访10-14个月,患者生活正常,需要激素替代治疗.结论 内镜扩大经鼻蝶窦入路可以安全有效地切除位于鞍上区、第三脑室内的颅咽管瘤,这种手术方式不需要牵拉脑组织,并能完全暴露视交叉后、下方区域,在直视下操作,有利于对下丘脑、垂体柄及其他重要结构的保护.对于选择性的颅咽管瘤病例,内镜扩大经鼻蝶窦入路是切除肿瘤的一种新型微创手术入路.神经导航可以验证解剖标记点,引导手术方向,增加手术安全性.

Abstract：

Objective To investigate the feasibility and efficacy of image -guided extended endoscopic endonasal transsphenoidal approach(EEETA) for the removal of craniopharyngiomas in the suprasellar region and third ventricle. Method A pure EEETA with image -guided system was used. Three patients with a craniopharyngioma involving the suprasellar region and third ventricle were treated. Results Total craniopharyngioma removal was achieved in three cases. All the patients recovered uneventfully. The follow - up study was carried out for 10 to 14 months with good outcomes. Compensatory endocrine substitution therapy was needed in all of them. Conclusions The EEETA for removal of craniopharyngiomas in the suprasellar region and third ventricle is feasible and effective. It has the advantages of no needing for brain retraction,offering panoramic view of retrochiasmatic and infrachiasmatic regions,manipulating under direct vision and protecting hypothalamus,pituitary stalk and other vital structures. The EEETA is a novel and minimally invasive approach for selected cases of craniopharyngioma. Neuronavigation plays an important role in identifying anatomic landmarks,guiding surgical direction and increasing safety of the operations.     

Establishing a protein expression profile database for the normal human pituitary gland using two-dimensional high-performance liquid chromatography combined with LTQ-Orbitrap mass spectrometry

In this study, we selected adult normal pituitary gland tissues from six patients during operations for pituitary microadenomas via the transsphenoidal approach for extended normal pituitary tissue resection around the tumor, and analyzed the protein expression of human normal pituitary using two-dimensional high-performance liquid chromatography combined with LTQ-Orbitrap mass spectrometry proteomics technology. The ten most highly expressed proteins in normal human pituitary were: alpha 3 type VI collagen isoform 5 precursor (abundance among tall pituitary proteins, 1.30%), fibrinogen beta chain preproprotein (0.99%), vimentin (0.73%), prolactin (0.69%), ATP synthase, H + transporting and mitochondrial F1 complex beta subunit precursor (0.52%), keratin Ⅰ (0.49%), growth hormone (0.45%), carbonic anhydrase Ⅰ (0.40%), heat shock protein 90 kDaⅠ (0.31%), and annexin V (0.30%). Based on the biological function classifications of these proteins, the top three categories by content were neuroendocrine proteins (abundance among all pituitary proteins, 40.1%), catalytic and metabolic proteins (28.3%), and cell signal transduction proteins (9.8%). Based on cell positioning classification, the top three categories were cell organelle (24.5%), membrane (20.8%), and cytoplasm (13.0%). Based on biological process classification, the top three categories of proteins are involved in physiological processes (42.9%), cellular processes (40.4%), and regulation of biological processes (9.1%). Our experimental findings indicate that a protein expression profile database of normal human pituitary can be precisely and efficiently established by proteomics technology.     

Gamma-knife for treating pituitary adenomas in 501 cases： Retrospective case analysis

BACKGROUND: Gamma-knife is characterized by low risk and low death rate, without trauma, bleeding or infection. MRI has replaced CT as a method of location, and provides a good choice for treating pituitary tumors. OBJECTIVE: To analyze the effectiveness and complications of 501 cases with pituitary adenoma by using gamma-knife retrospectively. DESIGN: Case-analysis. SETTING: Gamma-knife Center, the 363 Hospital of Chinese PLA. PARTICIPANTS: A total of 501 cases were selected from Gamma-knife Center, the 363 Hospital of Chinese PLA from January 1997 to December 2002. All patients were certainly diagnosed with CT and MRI scanning. There were 186 males and 315 females. Their ages ranged from 15 to 84 years with the mean age of 39 years. All patients provided confirmed consent. METHODS: All 501 cases with pituitary adenomas were treated by gamma-knife or combined with operations. The average iso-dose curve was 50% (30%–65%), peri-dose was 14 Gy and the average target number was 5.17. ① At 35 months after treatment, patients received follow-up including clinical symptoms, imaging symptoms and endocrine symptoms. ② Patients who received second gamma-knife treatment were analyzed and their complications were observed after operation. MAIN OUTCOME MEASURES: ① Follow-up results of clinical symptoms, image and endocrine indexes; ② second gamma-knife treatment; ③ postoperative complications. RESULTS: Among 501 accepted patients, 275 cases were involved in the follow up of clinical symptoms, 154 in image symptoms and 98 in endocrine symptoms. ① Follow-up results of clinical symptoms, image and endocrine indexes: Follow up of clinical symptoms demonstrated that clinical symptoms of 169 cases were relieved, of 68 disappeared, and of 38 deteriorated. Follow-up of image symptoms indicated that pituitary tumor of 25 cases disappeared, of 84 shortened, of 42 not changed, and of 3 enlarged. Follow-up of endocrine symptoms suggested that endocrine of 50 cases was abnormal, of 29 recovery to normal value, and of 19 not changed obviously. ② Second gamma-knife treatment: At 6–24 months after gamma-knife treatment, 15 patients with pituitary tumor received second gamma-knife treatment; especially, one patient received for the three times. The conditions in details were recorded as follows: The peri-dose for the first treatment ranged from 8 to 12 Gy; in addition, that for the second one ranged from 6 to 12 Gy. ③ Postoperative complications: The complications were as follow: hypopituitarism occurred in 2 patients (0.7%); tumor apoplexy in 2 patients (0.7%); weakened eyesight in 5 patients (1.8%); 3 of which recovered with dehydration and hormone treatment; 2 patients received tumor resection and optical nerve decompression operation with dehydration and hormone treatment ineffectively. CONCLUSION: Gamma-knife is effective and safe for pituitary adenoma.     

Combined high-field intraoperative magnetic resonance imaging and endoscopy increase extent of resection and progression-free survival for pituitary adenomas

PURPOSE The clinical benefit of combined intraoperative magnetic resonance imaging （iMRI） and endoscopy for transs- phenoidal pituitary adenoma resection has not been completely characterized. This study assessed the impact of microscopy, endoscopy, and/or iMRI on progression-free survival, extent of resection status （gross -, near -, and sub-total resection）, and operative complica- tions. METHODS Retrospective analyses were performed on 446 transsphenoidal pituitary adenoma surgeries at a single institution be- tween 1998 and 2012. Multivariate analyses were used to control for baseline characteristics, differences during extent of resection status, and progression-free survival analysis. RESULTS Additional surgery was performed after iMRI in 56/156 cases （35.9%）, which led to increased extent of resection status in 15/156 cases （9.6%）. Multivariate ordinal logistic regression revealed no increase in extent of re- section status following iMRI or endoscopy alone; however, combining these modalities increased extent of resection status （odds ratio 2. 05, 95% CI 1.21 -3.46） compared to conventional tranasphenoidal microsurgery. Multivariate Cox regression revealed that reduced ex- tent of resection status shortened progression-free survival for near-versus gross-total resection [ hazard ratio （HR） 2.87, 95% CI I. 24 - 6.65 ] and sub- versus near-total resection （HR 2.10; 95% CI 1.00- 4.40）. Complication comparisons between microscopy, endos- copy, and iMRI revealed increased perioperative deaths for endoscopy versus microscopy （4/209 and 0/237, respectively）, but this difference was non-significant considering multiple pest hoc comparisons （ Fisher exact, p = 0.24）. CONCLUSIONS Combined use of endoscopy and iMRI increased pituitary adenoma extent of resection status compared to conventional transsphenoidal microsurgery, and in- creased extent of resection status was associated with longer progression-free survival. Treatment modality combination did not significantly impact complication rate.     

单鼻孔经蝶窦入路切除垂体腺瘤并发症的预防与治疗

目的 探讨单鼻孔经蝶窦入路切除垂体腺瘤并发症的预防与治疗.方法 回顾性分析我科行单鼻孔经蝶窦入路切除垂体腺瘤412例,总结各类并发症的发生率及防治措施.结果 术后出现并发症72例(17.5%),其中尿崩44例(10.7%),垂体功能低下17例(4.1%),脑脊液鼻漏7例(1.7%),视力减退4例(1.0%),外展神经麻痹6例(1.5%),鼻腔出血3例(0.7%),术中大出血2例(0.5%),脑梗死1例(0.3%),无死亡病例.结论 单鼻孔经蝶窦入路切除垂体腺瘤手术并发症多与手术操作相关,熟悉局部显微解剖及娴熟的手术技巧可降低手术并发症的发生.     

儿童及青春期垂体腺瘤的诊断与手术治疗简

目的探讨儿童及青春期垂体腺瘤的临床特点、诊断及手术治疗。方法回顾性分析36例23岁及以下垂体腺瘤病人的临床特点、内分泌学检查、影像学检查、手术治疗特点及术后并发症。病人均行经蝶入路手术。结果肿瘤全切除35例,次全切除1例。术后得到缓解24例,缓解率达66．7％;异常的激素水平均不同程度改善。术后一过性尿崩症9例,电解质紊乱8例,甲状腺功能低下4例,皮质醇功能低下6例,颅内积气1例,单眼失明1例。有效随访23例,平均29．7个月,复发2例。结论儿童及青春期垂体腺瘤可通过临床表现、内分泌检查及影像学检查明确诊断：经鼻蝶人路垂体腺瘤切除术是儿童及青春期垂体腺瘤的主要治疗方法。     

经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤

目的 介绍经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤的经验及体会。方法 对16例垂体腺瘤病人采用经单鼻孔蝶窦入路行神经内镜下垂体腺瘤切除术，其中微腺瘤3例，大腺瘤12例，巨型腺瘤1例。功能性腺瘤14例，其中PRL腺瘤6例，GH腺瘤4例，混合性（PRL GH）腺瘤4例；无功能性腺瘤2例。结果 内镜下全切除肿瘤14例，近全切1例，大部切除1例；无死亡，无脑出血、视神经损伤、脑脊液鼻漏及其他鼻腔并发症发生；2例术后出现一过性多尿，经治疗术后1周恢复正常。随访3-6个月，原有症状均有所改善，异常增高的激素水平均降至正常，MRI检查显示下一例肿瘤复发。结论 内镜下经单鼻孔蝶窦入路垂体腺瘤切除术具有深部照明好，鼻腔结构损伤小，切除肿瘤彻底，术后并发症少，病人恢复快等优点。     

33例垂体卒中的临床分析

目的探讨和观察垂体卒中的临床特点及最佳治疗方案。方法回顾性分析2000—2006年我科收治的33例垂体卒中患者的临床资料，根据患者手术方式分为开颅组及经蝶组，比较术后患者视力改善情况及垂体功能低下的发生率。结果本组经蝶手术23例，其中视力完全恢复13例，明显恢复7例，略恢复3例，无视力障碍加重；10例术后发生垂体功能低下，其中6例需长期激素替代治疗。开颅手术10例，其中视力完全恢复3例，明显恢复3例，略恢复2例，视力障碍加重2例；8例术后发生垂体功能低下，其中5例需长期激素替代治疗。结论经蝶入路手术治疗垂体卒中创伤小、并发症少、疗效确实，术后垂体功能低下发生率低，可作为垂体卒中的首选手术入路。     

巨大垂体腺瘤的诊治

目的：探讨内镜经鼻蝶入路或联合翼点入路开颅手术分次切除巨大垂体腺瘤的治疗效果和并发症处理。方法回顾性分析45例巨大垂体腺瘤病人的临床资料,根据垂体瘤的不同生长类型,分别采取内镜经鼻蝶入路或联合翼点入路开颅手术分次切除肿瘤后,观察其临床疗效和术后并发症。结果一次手术肿瘤镜下全切除26例,次全切除12例,部分切除7例。两次手术全切除9例,次全切除6例。两次手术间隔时间为6~8周。术后并发症：一过性尿崩13例,脑脊液鼻漏5例,中枢性低钠血症2例,中枢性高热10例,垂体功能低下12例,以上均经术后对症支持治疗后好转或症状消失。蝶窦内感染3例,其中2例再次内镜下清理后好转,1例保守抗炎治疗痊愈。随访39例,时间2个月~3年,平均2.1年。复发9例,6例再次手术,余3例放弃治疗。结论对于巨大、向鞍上生长的垂体腺瘤,神经内镜和经颅手术联合分次切除肿瘤,是提高全切率、降低病死率及减少并发症的重要手段。     

内镜下经鼻蝶入路治疗儿童及青春期垂体腺瘤

目的探讨儿童及青春期垂体腺瘤的临床特点和内镜下手术治疗。方法回顾性分析31例20岁以下垂体腺瘤病人的临床资料,其中泌乳素腺瘤14例,促肾上腺皮质激素腺瘤8例,生长激素腺瘤6例,无功能性腺瘤3例。均行内镜下经鼻蝶入路垂体腺瘤切除术。结果肿瘤全切除28例,次全切除3例。手术并发症：暂时性尿崩症4例,脑脊液漏2例,水电解质紊乱4例。随访6个月～5年,治愈26例,缓解3例,复发2例。结论儿童及青春期垂体腺瘤多为功能性腺瘤,无功能腺瘤仅占少数。内镜下经鼻蝶入路手术是治疗儿童和青春期垂体腺瘤安全、有效的方法。     

经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤

目的 探讨神经内镜在经鼻蝶入路手术切除垂体腺瘤术中的应用价值和术中注意事项。方法 回顾性分析221 例垂体腺瘤手术病例的临床资料。手采用经单侧鼻孔蝶窦入路内镜下切除肿瘤,必要时在导航确认下进行。术后3个月复查头颅增强MRI判断肿瘤切除情况。结果 术中无定位错误病例,无大的血管和神经损伤病例。肿瘤全切除178例,次全切除37例,大部切除6例。术后死亡3例。术后无永久性尿崩和脑脊液漏病例,2例围手术期鼻腔大出血,治疗后好转。术前视力和视野障碍病人术后无恶化。结论 内镜结合导航经鼻蝶入路切除垂体腺瘤创伤小,导航可增加手术安全性和扩大手术适应症;充分的术前准备和规范的术中操作是预防术后并发症、提高手术疗效的关键。     

老年垂体腺瘤的诊断和治疗(附38例报告)

目的探讨老年垂体腺瘤的诊断和治疗特点。方法收集作者医院2003-06-2010-06间收治的老年垂体腺瘤患者38例,对其临床资料进行回顾性分析。结果临床表现为视力障碍23例(60.5%),头痛15例(39.5%),垂体功能低下12例(31.6%),伴有合并症30例(78.9%);MRI显示为直径≥2cm的大腺瘤和巨大腺瘤者30例(78.9%)。36例患者接受内镜经鼻蝶入路肿瘤切除术,其中肿瘤全切除23例(63.9%),近全切除5例(13.9%),部分切除8例(22.2%),术中无死亡。术后对27例患者随访6～36个月(中位随访时间24个月),视力、视野障碍均有所改善。需长期激素替代治疗的11例患者无垂体功能低下表现。有残余肿瘤者10例,其中4例行伽马刀治疗,治疗后残余肿瘤均缩小。结论老年垂体腺瘤主要表现为视力障碍和垂体功能低下,内镜经鼻蝶入路手术是安全、有效的治疗方法。     

经单鼻孔蝶窦入路显微手术切除大型垂体腺瘤

目的探讨经单鼻孔蝶窦入路手术切除大型垂体腺瘤(最大径>3cm)的效果及其手术技巧。方法回顾性分析经单鼻孔蝶窦入路手术切除的43例大型垂体腺瘤患者的临床资料。结果肿瘤全切除31例,次全切除8例,大部分切除4例。术后1周视力下降、视野缺损改善36例。术后出现一过性尿崩症11例,脑脊液鼻漏2例,迟发性鼻腔出血1例。本组无死亡病例。术后42例随访3月～2年,视力下降、视野缺损均有不同程度改善,头部MRI示肿瘤无残留29例,部分残留13例。结论经单鼻孔蝶窦入路手术可有效切除大型垂体腺瘤,但需熟练掌握手术技巧,减少肿瘤残留。     

经蝶垂体腺瘤手术并发症

目的 分析经蝶入路切除垂体腺瘤的手术并发症。方法 回顾性分析1980年3月～2005年9月我科2103例经蝶手术的垂体腺瘤病人术后并发症。结果 尿崩症发生率为18．1％，低钠血症3．6％，视力恶化1．7％，垂体功能低下2．0％，中枢神经损伤1．0％，眼肌麻痹1．5％，脑脊液鼻漏2．2％，颈动脉损伤0．8％，鼻衄0．2％，严重蛛网膜下腔出血0．3％，残瘤出血或肿胀0．4％，脑膜炎0A％，病死率0．8％。结论 熟悉手术局部解剖，把握手术适应证，熟练掌握手术技能、不断总结临床实践经验，才能降低手术并发症和病死率，提高治疗效果。