摘要
目的总结神经导航下经蝶手术治疗侵袭型功能性垂体腺瘤的疗效,并讨论其治疗策略。方法对30例神经导航下经蝶侵袭型功能性垂体腺瘤手术病例进行回顾性分析。所有肿瘤均侵犯海绵窦(KnospⅢ级以上),其中9例同时侵犯鞍区或斜坡骨质。垂体大腺瘤17例,巨大腺瘤13例。首次经蝶手术者22例,既往经蝶手术后复发再次经蝶手术者8例。所有病例均在神经导航下经蝶手术。结果所有病例均成功完成手术。肿瘤全部切除4例,近全切除16例,大部切除10例。术后出现瘤腔血肿1例,脑脊液漏并颅内感染1例,无死亡和永久性并发症。垂体泌乳素腺瘤7例,进步6例,无效1例;垂体生长激素腺瘤21例,进步11例,无效10例;促肾上腺皮质激素腺瘤1例无效;促甲状腺激素腺瘤1例进步。复发组和首次经蝶手术组之间、大腺瘤组和巨大腺瘤组之间的疗效均无统计学差异,肿瘤切除程度对其生物学疗效也无显著性影响。结论神经导航在一定程度上增加了侵袭型功能性垂体腺瘤的经蝶手术切除程度,但其生物学疗效仍差。侵袭型功能性垂体腺瘤需要采用手术、放疗和(或)药物治疗的综合治疗方法。
Objective To summarize transsphenoidal microsurgical results of invasive functional pituitary adenomas under neuronavigation,and to discuss their treatment strategies.Methods 30 cases of transsphenoidal microsurgeries for invasive functional pituitary adenomas under neuronavigation were reviewed.Parasellar extension of the tumor was measured according to the Knosp Scale.All the tumors had extended to cavernous sinus (Knosp Scale Ⅲ or Ⅳ),among which 9 had invaded the bone of sella or clivus.17 patients had macroadenomas (>10 mm),and 13 patients had giant adenomas (≥30 mm).22 patients received transsphenoidal microsurgery for the first time and 8 patients received repetitive transsphenoidal microsurgery due to tumor recurrence after former transsphenoidal surgery.All the transsphenoidal microsurgeries were guided by intraoperative neuronavigation.Results All the 30 cases were successfully operated under neuronavigation.The tumors were totally removed in 4 cases,subtotally removed in 16 cases and largely removed in 10 cases.Postoperative complications included transient fluid and electrolyte imbalance in 14 cases,hematoma within the tumor cavity in 1 case,CSF leakage with intracranial infection in 1 cases.There were no mortality and permernent morbidity.All the patients were followed up for 3 to 62 months.Among the 7 prolactinomas,6 were improved and 1 ineffective.Among the 21 GH-secreting adenomas,11 were improved and 10 ineffective.1 ACTH-secreting adenoma was ineffective and 1 TSH-secreting adenoma was improved.The tumor size,the tumor removal extent and whether it be primary or repetitive transsphenoidal microsurgery had no significant influence on the biological results.Conclusions Transsphenoidal microsurgery under neuronavigation can increase the removal extent for invasive functional pituitary adenomas,while their biological results are still embarrassing,which suggest that invasive functional pituitary adenomas need combined treatments of surgery,radiotherapy and/or medical therapy.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第21期6291-6294,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
功能性垂体腺瘤
神经导航
经蝶手术
Functional pituitary adenoma
Neuronavigation
Transsphenoidal microsurgery
