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。     

垂体瘤的诊断、鉴别诊断与治疗——经鼻蝶入路垂体瘤切除术的围手术期护理

经鼻蝶入路垂体瘤切除术是近年来最常见手术治疗垂体瘤的方法，其具有并发症少，创伤小，失血量少，手术时间短，痛苦少，恢复快等优点。做好围手术期护理对促进患者良好恢复亦很重要。     

内镜下经鼻蝶入路垂体瘤切除术后护理体会

2001年1月至2004年8月，我们在内镜下经鼻蝶入路切除垂体瘤62例。术后经精心护理与治疗，均痊愈。现将术后护理方法与体会报告如下。     

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。     

经鼻蝶入路垂体瘤切除术后三大并发症的护理

2000年1月至2004年10月，我科采用经鼻蝶人路行垂体瘤手术472例，并发尿崩症、脑脊液鼻漏、低钠血症者共42例。现将此三大术后并发症的护理体会总结如下。     

神经内镜下“一侧半”经鼻-蝶窦入路切除术对高龄垂体瘤患者的疗效及术后复发的危险因素

目的探讨神经内镜下"一侧半"经鼻-蝶窦入路切除术治疗高龄垂体瘤的效果,观察其对患者恢复情况、视觉功能和血清皮质醇(COR)、肾上腺皮质激素(ACTH)水平的影响,同时对术后复发的危险因素进行分析。方法采用前瞻性试验研究方法,选取62例高龄垂体瘤患者作为研究对象,对照组行经口鼻下鼻中隔垂体瘤切除术治疗(n=31),观察组行神经内镜下"一侧半"经鼻-蝶窦入路切除术治疗(n=31)。比较两组手术指标、治疗效果、复发情况及治疗前后应激水平、视觉功能、垂体功能相关指标变化情况。根据复发情况分为复发组和未复发组,应用单因素和多因素Logistic回归分析对术后复发的影响因素进行分析。结果(1)观察组手术时间、住院时间、术中出血量均明显少于对照组,观察组血管紧张素(Ang)Ⅱ、血管紧张素原酶(R)、去甲肾上腺素(NE)水平均明显低于对照组(均P<0.001)。(2)观察组治疗总有效率(93.55%)明显高于对照组(74.19%,P<0.05),观察组肿瘤残留率、术后1年复发率和手术并发症发生率均明显低于对照组,观察组肿瘤体积缩小率和激素水平降低均明显高于对照组(均P<0.05)。(3)两组患者术后第2天COR较术前明显升高,ACTH明显降低,对照组术后第30天COR明显高于术前,ACTH明显低于术前,且观察组术后COR明显低于对照组,ACTH明显高于对照组(均P<0.05);两组患者术后30 d的VFI、MD均高于术前,而PSD低于术前,且观察组术后30 d的VFI、MD均高于对照组,PSD低于对照组(均P<0.05)。单因素和多因素Logistic回归分析显示,肿瘤直径、手术全切、肿瘤侵袭性、术后并发症是术后复发的独立影响因素。结论神经内镜下"一侧半"经鼻-蝶窦入路切除术治疗老年垂体瘤,对病灶的掌控能力更好,可提高肿瘤全切除率,有助于降低应激反应,改善视觉功能和垂体功能,减少并发症的发生。     

经鼻蝶入路垂体瘤切除术的护理

经鼻蝶入路切除垂体瘤是近几年来应用于临床的微创手术,该术式不仅是治疗垂体瘤的有效方法,而且具有手术创伤小、肿瘤切除彻底,手术和麻醉时间短,并发症低,反应轻,已被临床广泛应用.现将经鼻蝶入路切除垂体瘤的护理体会总结如下.     

经鼻蝶入路垂体瘤切除术后并发症的护理

2000年9月～2004年9月，本院行经鼻蝶入路垂体瘤切除术38例，取得良好效果。现将护理方法介绍如下。 临床资料：本组38例中，男16例，女22例；年龄27～54岁。全部病例均有头痛，肢端肥大2例，闭经、泌乳20例，视力减退16例。MRI检查垂体肿瘤直径〈1．0cm者20例，1．0～3．0cm者18例。术后头痛、视力障碍、闭经、泌乳症状均有不同程度的改善，垂体激素水平基本恢复正常。术后并发轻度脑脊液鼻漏3例．尿崩症6例，均经保守治疗后痊愈。     

经鼻蝶入路显微外科治疗老年垂体腺瘤68例临床经验

目的 探讨经鼻蝶入路显微外科治疗老年垂体腺瘤的治疗结果 .方法 2000年12月至2007年12月期间68例老年垂体腺瘤的病例在我院接受经鼻蝶入路显微外科切除.通过其治疗效果进行分析,总结治疗经验.结果 术中15例发生脑脊液漏,采用鞍底重建.10例垂体腺瘤巨大,手术无法全切,术后辅以伽马刀放射治疗.5例术后发生严重的电解质紊乱及尿崩,8例术后发生垂体功能低下.随访1年,未见肿瘤复发,恢复良好.结论 经鼻蝶入路显微外科治疗老年垂体腺瘤,由于其术中损伤小,术后恢复快,能有效的治疗老年垂体腺瘤,获得满意的效果.     

经鼻蝶入路切除垂体腺瘤及斜坡肿瘤96例手术体会

自1993年以来，我们采用经鼻蝶人路垂体腺瘤切除89例，斜坡肿瘤7例，效果满意。现报告如下。     

Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery

Purpose

Transsphenoidal pituitary surgery can be carried out with either an operating microscope or with an endoscope, but the relative frequency of both techniques is unknown.

Methods

All microscopic and endoscopic transsphenoidal pituitary surgeries were extracted from the Centers for Medicare and Medicaid Services Part B data files between the years 2003 and 2013. National and state-level trends were compared over time.

Results

Endoscopic surgery significantly increased and microscopic surgery significantly decreased over the years 2003–2013. Thirty-eight of 48 states increased their use of endoscopic surgery, while 38 of 48 states decreased their use of microscopic surgery.

Conclusions

Nationwide data show a clear trend for an increasing use of endoscopic transsphenoidal surgery at the expense of microscopic surgery. The underlying causes of these trends are unknown, but clearly deserve further investigation.

     

Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas

It is widely accepted that the standard first-line treatment for most endocrine inactive pituitary macroadenomas (EIA) is surgery, usually via a transsphenoidal approach. What is less clear is what approach to take when these tumors recur, especially when this recurrence involves areas which are difficult to surgically remove tumor from, such as the suprasellar region or cavernous sinuses. We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years. The mean tumor size was 2.2 ± 0.2 cm. A total of 35/81 patients had greater than 5 years of follow-up. A total of 24/81 patients had greater than 10 years of follow-up. Over one half of these patients presented with visual disturbance, and we found that 39% of these patients experienced improved vision with a second surgery. More importantly, no one with normal vision suffered any appreciable decline in vision. Approximately, 35% of patients with pre-operative anterior pituitary dysfunction recovered function after surgery in our series; and no patient’s function worsened. A total of 4/52 (8%) patients with greater than 2 years of post-op follow-up experienced a clinically meaningful tumor recurrence requiring additional treatment. Our data suggest that when performed by experienced transsphenoidal surgeons, durable tumor control can be obtained in these frequently locally aggressive tumors with acceptable rates of post-operative morbidity.     

垂体腺瘤鼻内镜蝶窦入路手术的局部影像解剖学测量

目的为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。方法利用双源CT三维重建技术对100例（200侧）鼻、鼻窦及颅底正常的受试者行蝶窦、蝶鞍区有关解剖数据的测量。结果鼻小柱根部至蝶窦前壁最近点、蝶嘴最前端、蝶鞍底最近点、蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的距离分别为（65.91±5.38）、（72.36±6.79）、（84.29±4.37）、（69.97±5.33）、（87.41±5.04）、（76.76±4.15）mm,鼻小柱根部至以上各解剖结构连线与鼻底平面的矢状角分别为25.17°±6.79°、16.19°±6.68°、26.12°±6.59°、31.17°±6.50°、23.64°±5.60°、38.15°±6.07°,鼻小柱根部至蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的连线与颅脑正中矢状面的侧偏角分别为4.13°±1.47°、7.92°±1.41°、11.28°±1.89°。结论利用双源CT三维重建技术可以地为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。     

Frailty does not preclude surgical success after endoscopic transsphenoidal surgery for pituitary adenomas

Pituitary - Frailty is a state of physiological vulnerability that negatively influences surgical outcomes. The effect of frailty on pituitary adenoma surgery, however, is not clear, and patients...     

Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery

Endoscopy in combination with extended approaches allow for resection of large pituitary adenomas via a transsphenoidal route. The objective of the current study was to determine a volumetric threshold for lesions with high perioperative morbidity and high rate of subtotal resection following endonasal endoscopic surgery. Thus, we analyzed a prospectively collected database of 71 patients who underwent endoscopic transsphenoidal approaches for macroadenomas (diameter >1 cm). Extend of resection (EOR) was calculated based on volumetric analysis of pre-and post-operative contrast-enhanced MRI. Average EOR was 97.8% and a gross total resection (GTR) was achieved in 76.1% of all patients. GTR was accomplished in 92.0% versus 38.1% of adenomas either without or with CS invasion, respectively. Likewise, GTR was accomplished in 90.2% versus 40.0% of lesions less than or greater then 10 cm(3) respectively. However, even if only subtotal resection was achieved, 90.3% of tumor volume was removed. At 17 months follow-up, visual field defects improved in 80.8% of patients. Complications included permanent diabetes insipidus (5 patients), panhypopituitarism (4 patients), injury to the ophthalmic artery (1 patient) and CSF leak (1 patient). On multivariate logistic regression, two factors negatively predicted GTR: invasion of the CS and volume greater than 10 cm(3). A 10 cm(3) threshold was a stronger predictor of EOR and complication risk than diameter-based measurements. A volume greater than 10 cm(3) and CS invasion may help to identify pituitary lesions associated with a higher likelihood of subtotal resection and post-operative morbidity.     

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Background  No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available.
Design and patients  We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent ( N  = 6) or recurrent ( N  = 8) Cushing's disease treated in our centre between 1999 and 2007.
Main outcomes  Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l 24–48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ≤ 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery.
Results  With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries.
Conclusion  Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.     

Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery

Pituitary - Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and...