摘要
目的 分析导航辅助内镜下经鼻蝶窦垂体腺瘤切除术的疗效.方法 回顾性分析山西省人民医院神经外科自2011年7月至2014年7月采用内镜经鼻蝶窦垂体腺瘤切除术治疗的患者,共139例.其中男55例,女84例.年龄21 ～73（48.9）岁.按Hardy-Wilson分级：Ⅰ级16例,Ⅱ级39例,Ⅲ级48例,Ⅳ级36例.所有患者术中均使用神经导航辅助.术后行视力、神经影像及内分泌随访.结果 全切除肿瘤95例（68.3％）,次全切33例（23.7％）,部分切除11例.Hardy-WilsonⅠ级全切除肿瘤16例（占100％）,Ⅱ级全切除肿瘤35例（89.7％）,Ⅲ级全切除肿瘤34例（70.8％）,Ⅳ级全切除肿瘤10例（27.8％）.术后视力视野改善70例,有效率为92.1％（70/76例）,内分泌治愈率59.6％（53/89例）.术后发生脑脊液鼻漏8例（5.8％）,术后3例颅内感染,（2.2％）,术后5例行鞍区血肿清除术,1例术后出现迟发性颈内动脉动脉破裂,出血性休克,紧急行介入栓赛治疗后抢救成功,痊愈出院.结论 内镜下经鼻蝶窦垂体腺瘤切除术安全、有效,结合神经导航技术可进一步增加其安全性和有效性.
Objective To explore the efficacies of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for removing pituitary adenomas.Methods Retrospective analyses were conducted for the clinical data of 139 patients undergoing pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between July 2011 and July 2014.There were 55 males and 84 females with a mean age of 48.9 （21-73） years.The classifications of Hardy-Wilson were Ⅰ （n =16）,Ⅱ （n =39）,Ⅲ （n =48） and Ⅳ （n =36）.Neuronavigation was used in all patients.And neuro-ophthalmological,neuroimaging and endocrinological follow-ups were conducted postoperatively.Results Total （n =95,68.3%）,subtotal （n =33,23.7%） and partial （n =11,7.9%） removals were achieved.For HardyWilson Ⅰ,gross total removal was achieved （n =16,100%） ; Hardy-Wilson Ⅱ （n =35,89.7%）,Hardy-Wilson Ⅲ （n =34,70.8%） and Hardy-Wilson Ⅳ （n =10,27.8%）.Postoperative visual acuity improved （92.1%,70/76） and endocrine remission was observed （59.6%,53/89）.The postoperative complications included cerebrospinal fluid （CSF） leakage （n =8,5.8%）,meningitis （n =3）,sellar hematoma （n =5） and delayed carotid artery rupture （n =1）.And the patient of hemorrhagic shock underwent emergency interventional procedures and was discharged successfully.Conclusion Pure endoscopic endonasal transsphenoidal approach for removing pituitary adenoma is both safe and effective.And its efficacies may further increased through combined neuronavigation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第5期339-343,共5页
National Medical Journal of China
基金
国家自然科学基金（30901774）,山西省科学技术发展计划项目（20140313011-5）,山西省自然科学基金（2014011038-2）
关键词
神经内镜
神经导航
垂体腺瘤
经蝶入路
Neuroendoscopy
Neuronavigation
Pituitary adenoma
Transsphenoidal approach
