MRI影像学检查在垂体腺瘤内镜切除术中的应用价值

目的分析MRI影像学检查在垂体腺瘤内镜切除术中的应用价值。方法将我院2012年3月-2015年5月收治的36例有明确手术指征的垂体腺瘤患者作为研究对象,在MRI辅助下作经鼻-碟入路垂体瘤切除术,术中继续作MRI扫描,确定是否扩大肿瘤切除范围,对肿瘤切除已术前要求者,结束手术,合并残留者扩大手术范围后再作MRI扫描,重复确认直至肿瘤完全切除,分析MRI辅助下内镜手术对垂体腺瘤患者垂体功能的保护作用。结果 36例垂体腺瘤患者6例肿瘤局限于鞍内,术后MRI扫描未见肿瘤残留;30例肿瘤自鞍旁、鞍上生长者,术中扫描9例可见肿瘤残留,作残留肿瘤进一步切除处理,其中7例肿瘤完全切除,2例未完全切除。扩大切除前患者垂体腺瘤全切率为75.00%,扩大切除后全切率高达94.44%,明显高于扩大切除前(P0.05);36例缓解完全缓解12例,部分缓解20例,稳定3例,进展1例,总缓解率为88.89%。结论将高场强术中MRI系统应用于垂体瘤切除术中,可提高手术根除率,保障手术的安全性,实时并客观评估手术结果,同时可鉴别保护垂体周围解剖结构,避免手术误伤,降低了手术风险。

Application Value of MRI Imaging Examination in the Endoscopic Resection of Pituitary Adenoma

Objective To analyze the application value of MRI imaging examination in the endoscopic resection of pituitary adenoma.Methods 36 patients with pituitary adenoma who had definite surgical indications treated in our hospital from March 2012 to May 2015 were taken as the research objects. With the assist of MRI, transnasal transsphenoidal approach resection of pituitary adenoma was performed and MRI scan was continued during surgery to determine whether to expand the scope of tumor resection. For patients who had requirements for tumor resection, the surgery was ended. After expanding the scope of surgery in patients with residual, they were scanned by MRI. Repeated confirmation was performed until complete resection of the tumor. The protective effect of MRI assisted endoscopic surgery in pituitary function of patients with pituitary adenomas.Results In the 36 cases of patients with pituitary adenomas, there were 6 cases whose tumors were confined to the saddle. Postoperative MRI scan showed no tumor residual. The intraoperative scan of 30 cases of patients whose tumors were grown beside the saddle or on the saddle showed tumor residual which were removed furtherly. 7 cases were completely resected and 2 cases were incompletely resected. The total resection rate of pituitary adenoma in patients before extended resection was 75.00%. After extended resection, the total resection rate rearched 94.44% which was significantly higher than before extended resection (P<0.05). In 36 cases, 12 cases were completely remitted and 20 cases were partially remitted, 3 cases were stable and 1 case was in progress. The total remission rate was 88.89%.Conclusion To apply high-field intraoperative MRI system in resection of pituitary adenomas can improve the eradication rate of surgery, ensure the safety of surgery, objectively evaluate the surgical results in real time and differentially protect the anatomical structures around the hypophysis at the same time. It also can avoid surgical injury and reduce the risk of surgery.