摘要
目的观察及总结显微镜及内镜辅助下经鼻蝶垂体瘤切除术的临床疗效及手术体会。方法回顾性分析从2007年1月-2017年12月收治的垂体瘤患者76例。其中无功能腺瘤23例,功能性腺瘤53例。均行显微镜及内镜辅助下经鼻蝶垂体瘤切除术。术后神经影像及内分泌随访3~24个月。结果所有病例全切除70例(92.1%,70/76),次全切除6例。头痛头晕好转45例(100.0%),性功能减退好转22例(100.0%),视力视野障碍恢复好转27例(81.8%,27/33)。全切除患者同次全切除患者在症状好转率方面差异无统计学意义(χ^2=1.806,0.478,1.012,P>0.05)。临床症状均得到明显改善,其中头痛头晕、性功能减退、停经泌乳、Cushing病容好转率100.0%,视力视野障碍恢复好转率81.8%,肢端肥大症状改善率42.8%。术后激素水平均下降至正常或明显下降。4例合并低钠血症,4例合并脑脊液鼻漏,5例合并尿崩,12例合并垂体功能低下,4例合并血糖偏高,均经治疗好转。并发症出现率38.2%。未出现颅内出血、颅内感染及死亡病例。结论显微镜及内镜辅助下经鼻蝶垂体瘤切除术疗效确切,创伤小,术后患者恢复快,并发症发生率低,值得临床推广应用。
Objective To observe and summarize the clinical efficacy and surgical experience of transsphenoidal pituitary adenoma resection under microscope and endoscopy.Methods A retrospective analysis of 76 patients with pituitary tumors admitted from January 2007 to December 2017 was performed.There were 23 cases of non-functioning adenoma and 53 cases of functional adenoma.All patients underwent microsurgical and endoscopic assisted transsphenoidal pituitary tumor resection.Postoperative neuroimaging and endocrine follow-up were 3-24 months.Results All cases were completely resected in 70 cases(92.1%,70/76)and subtotal resection in 6 cases.Headache and dizziness improved in 45 cases(100.0%),sexual function decreased in 22 cases(100.0%),and visual field visual field disorder improved in 27 cases(81.8%,27/33).There was no significant difference in the rate of symptom improvement between pa tients who underwent total resection,the difference was statistically significant(χ^2=1.806,0.478,1.012,P>0.05).The clinical symptoms were significantly improved,including headache,dizziness,sexual dysfunction,menopause and lactation,Cushing disease rate improvement rate of 100.0%,visual field vision recovery rate of 81.8%,and acromegaly symptom improvement rate of 42.8%.Postoperative hormone levels decreased to normal or significantly decreased.4 cases with hyponatremia,4 cases with cerebrospinal fluid rhinorrhea,5 cases with diabetes collapse,12 cases with hypopituitarism,4 cases with high blood glucose,all improved after treatment.The incidence of complications was 38.2%.There were no cases of intracranial hemorrhage,intracranial infection and death.Conclusion Microscopic and endoscopically assisted transsphenoidal pituitary adenoma resection is effective,with minimal trauma,rapid recovery after surgery,and low complication rate,which is worthy of clinical application.
作者
金科
褚荣涛
孙成法
张志越
程序曲
施振华
支文勇
赵富文
JIN Ke;CHU Rong-tao;SUN Cheng-fa;ZHANG Zhi-yue;CHENG Xu-qu;SHI Zhen-hua;ZHI Wen-yong;ZHAO Fu-wen(Department of Neurosurgery,Taicang City Hospital of Traditional Chinese Medicine,Taicang,Jiangsu Province,215400 China;Department of Neurosurgery,Second People's Hospital of Changshu,Changshu,Jiangsu Province,215500 China)
出处
《系统医学》
2019年第18期13-16,共4页
Systems Medicine
关键词
垂体腺瘤
神经内镜
经鼻蝶手术
Pituitary adenoma
Neuroendoscopy
Transsphenoidal surgery
