单纯神经内镜下经鼻蝶入路垂体瘤切除术

目的 分析单纯神经内镜经鼻蝶入路手术在垂体瘤外科治疗中的应用.方法 回顾2006年12月至2009年12月开展的375例神经内镜垂体瘤手术,其中男性177例,女性198例;年龄12～87岁,平均38.3岁.375例垂体瘤中,无功能性垂体瘤201例,分泌性垂体瘤174例(泌乳素瘤88例,生长激素瘤63例,促皮质激素瘤23例).其中巨大垂体瘤27例(7.2%),侵入海绵窦41例(10.9%).术中结合内镜应用了高场强术中磁共振和神经导航.术后和长期随访中进行视力、内分泌及影像学检查.结果 随访成功295例,其中全切除234例(79.3%),次全切除56例(19.0%),部分切除5例(1.7%).视力改善68例(93.0%,68/73).内分泌改善:泌乳素77.3%(68/88),生长激素84.1%(55/63),促皮质激素78.2%(18/23).手术并发症:无死亡,术后昏迷1例(0.3%),视力一过性下降2例(0.5%),动眼神经或外展神经一过性麻痹7例(2.1%),术后脑脊液鼻漏2例(0.5%),脑膜炎3例(0.8%).结论 内镜为经鼻蝶垂体瘤手术提供了一个全新的手段,手术效果好,安全性高.

Pure endoscopic endonasal transsphenoidal approach for 375 pituitary adenomas

Objective To describe the experience with surgical treatment of pituitary adenomas via a fully transnasal endoscopic approach. Methods Clinical records of 375 cases with pituitary adenomas underwent pure endoscopic operations between December 2006 and December 2009 were carefully assembled. Among 375 pure endoscopic operations of pituitary adenomas, 201 cases were nonfunctional adenomas and 174 cases were fuctional adenomas. There were 27 giant pituitary adenomas (7.2%)and 41 pituitary adenoma invaded cavernous sinus (10. 9% ). Intraoperative 1.5 T MRI and neuro-navigation system were used during some operations. The postoperative and follow-up data of patients were analyzed. Results There were 234 (79. 3% )cases of total resection, 56 (19. 0% )cases of subtotal resection, 5(1.7% )cases of partial resection. Sixty-eight patients had vision improved in 73 patients with vision decreasing before operation. Sixty-eight(77. 3% )patients got normal endocrine in 88 hyper-prolactin patient. Fifty-five (84. I% )patients got normal growth hormone in 63 patients with somatotrophinomas. Eighteen (78. 2% )patients got normal in 23 patients with corticotrophinona. These was no death case in this group.One case(0. 3% )suffered post-operative coma. Transient decreasing of vision occurred in 2 cases(0. 5% ).Transient palsy of oculomotor nerve or abducens nerve occurred in 7 cases of operations involved rcavernoussinus. Three(0. 8% )patients had cerebral meningitis. Two patients(0. 5% )suffered from cerebrospinal fluid leak but none underwent operation to repair. Fourteen patients(3.7% )had transient diabetes insipidns. Six patients(1.6% )had nose bleeding. Conclusions Trans-nasal endoscopy provids a new device for operation of pituitary adenomas which is effective and safe. Comparing with microscope, endoscopic visual field is clearer, closer and wider.