摘要
目的探讨神经内镜经鼻蝶入路假包膜外分离技术切除垂体腺瘤对肿瘤切除程度、内分泌缓解和术后并发症的影响。方法回顾性分析2015年2月至2017年12月徐州医科大学附属医院神经外科由同一手术组采用内镜经鼻蝶入路手术的43例患者的临床资料,将其分为假包膜外分离组22例和包膜内切除组21例,比较2组患者肿瘤切除程度、内分泌缓解和并发症发生情况。结果假包膜外分离组和包膜内切除组肿瘤切除程度分别是95.5%(21/22)、71.4%(15/21),假包膜外分离组在肿瘤切除程度上较包膜内切除组全切率增高,差异有统计学意义(P=0.046);假包膜外分离组对功能性垂体腺瘤内分泌缓解率为90.9%(10/11),明显高于包膜内切除组的42.9%(3/7),2组比较差异有统计学意义(P=0.047);假包膜外分离组术中脑脊液漏发生率为45.5%(10/22),高于包膜内切除组的14.3%(3/21),但2组患者术后脑脊液鼻漏和暂时性尿崩症的发生率差异无统计学意义(P>0.05)。结论神经内镜经鼻蝶入路假包膜外分离技术切除垂体腺瘤,可以提高肿瘤的全切除率和功能性腺瘤内分泌缓解率,且不增加术后脑脊液鼻漏、暂时性尿崩症的发生率。
Objective To investigate the effects of extra-pseudocapsule dissection technique on the tumor resection and endocrinological remission and postoperative complications in endoscopic transsphenoidal surgery for pituitary adenoma. Methods A retrospective analysis was performed on clinical data of 43 patients with pituitary adenoma,who underwent endoscopic endonasal transsphenoidal surgeries from February 2015 to December 2017. Patients were divided into the extra-pseudocapsule dissection group（ n = 22） and the intra-capsular resection group（ n = 21） to compare the tumor resection and endocrinological remission and postoperative complications. Results The tumor total resection rates of extra-pseudocapsule dissection group and intra-capsular resection group were 95. 5%（ 21/22） and 71. 4%（ 15/21）,respectively; the degree of resection of the former was higher than that of the latter and the difference between them was statistically significant（ P =0. 046）. In extra-pseudocapsule dissection group,the endocrinological remission rate of functional pituitary adenomas was 90. 9%（ 10/11）,and it was significantly higher than that in intra-capsular resection group 42. 9%（ 3/7） with statistically significant difference（ P = 0. 047）.Cerebrospinal fluid leakage rate was 45. 5%（ 10/22） in extra-pseudocapsule dissection group,which was higher than 14. 3%（ 3/21） in intracapsular resection group,but there was no statistical significance in the incidence of the cerebrospinal fluid rhinorrhea and temporary diabetes insipidus after operation in both groups（ P〉 0. 05）. Conclusion The application of the extra-pseudocapsule dissection technique in neuroendoscopic transsphenoidal surgery for pituitary adenoma can improve the tumor total resection rate and the endocrinological remission rate of functional adenoma. The extra-pseudocapsule dissection technique does not cause additional postoperative complications such as cerebrospinal fluid rhinorrhea and temporary diabetes insipidus.
作者
徐强
赵传
王勇
刘厚强
朱玉辐
XU Qiang;ZHAO Chuan;WANG Yong;LIU Hou-qiang;ZHU Yu-fu(Department of Neurosurgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)
出处
《局解手术学杂志》
2018年第6期437-442,共6页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金青年项目(81502153)
关键词
垂体腺瘤
神经内镜
假包膜
经鼻蝶入路
pituitary adenoma
neuroendoscopy
pseudocapsule
endonasal transsphenoidal approach
