摘要
目的探讨神经内镜经鼻垂体腺瘤切除术中对正常垂体边界的判断方法及其临床意义。方法回顾性分析2010年1月至2013年12月空军军医大学西京医院神经外科收治的、经病理学证实的502例垂体腺瘤患者的临床资料。分析患者的术前影像和手术视频资料,总结确定垂体边界、垂体保护的方法。根据术前、术后的MRI影像评估肿瘤切除程度,并评估术后并发症的发生情况。结果502例患者中,达到肿瘤全切除463例(92.2%)。通过术前影像和术中神经内镜直视或应用术中潜水技术观察,483例(96.2%)患者术中可辨认出正常垂体以及垂体与肿瘤组织的边界,垂体组织保留良好;19例(3.8%)患者无法辨认垂体组织,术中对可能的垂体边界组织进行快速冰冻病理学检查,结果提示,单纯垂体组织12例,被肿瘤侵袭的垂体组织3例,单纯肿瘤组织4例。术后并发症包括嗅觉丧失(1.6%,8/502)、尿崩症(1.4%,7/502)、电解质紊乱(1.0%,5/502)、脑脊液鼻漏(1.0%,5/502)、脑膜炎(0.4%,2/502)及垂体功能低下(0.4%,2/502),无死亡病例。结论大多数垂体腺瘤患者通过术前影像结合术中神经内镜直视或术中潜水技术观察可辨认出垂体组织与肿瘤的边界,对于难以辨认垂体边界的患者,术中可通过快速冰冻病理学检查予以确认。采用这一方法可提高对垂体组织的辨识率,有利于对垂体的保护,从而减少术后并发症。
Objective To explore the method of identifying the boundary of the normal pituitary gland during neuroendoscopic transnasal pituitary adenoma resection and its clinical significance.Methods A retrospective analysis was conducted on the clinical data of 502 patients with pathologically confirmed pituitary adenomas who were admitted to the Department of Neurosurgery,Xijing Hospital,Air Force Medical University from January 2010 to December 2013.We analyzed the patients/preoperative imaging and surgical video data,and summarized the methods for determining the pituitary border and pituitary protection.According to the preoperative and postoperative MRI images,the degree of tumor resection was evaluated.The occurrence of postoperative complications was confirmed.Results Among 502 patients,total resection was achieved in 463(92.2%).Through preoperative imaging and direct observation under neuroendoscope or through intraoperative diving technique,we were able to recognize the normal pituitary gland and the boundary between the pituitary gland and the tumor tissue in 483 cases(96.2%)during the operation,and the pituitary gland tissue was well preserved;we were unable to identify the pituitary tissue in 19 cases(3.8%),and frozen section was made from the possible pituitary border tissue during the operation for pathological examination.The results showed that there were 12 cases of pure pituitary tissue,3 cases of pituitary tissue invaded by tumor,and 4 cases of merely tumor tissue.Postoperative complications included loss of smell(1.6%,8/502),diabetes insipidus(1.4%,7/502),electrolyte disturbance(1.0%,5/502),cerebrospinal fluid rhinorrhea(1.0%,5/502),meningitis(0.4%,2/502)and hypopituitarism(0.4%,2/502).There were no deaths in this series.Conclusions For most patients with pituitary adenomas,the boundary between the pituitary tissue and the tumor could be identified through preoperative imaging combined with intraoperative endoscopic direct vision or intraoperative diving techniques.For patients whose pituitary boundari
作者
伊西才
孙刚锋
高大宽
董秋峰
周跃飞
刘宇琪
闫志强
黑悦
刘卫平
Yi Xicai;Sun Gangfeng;Gao Dakuan;Dong Qiufeng;Zhou Yuefei;Liu Yuqi;Yan Zhiqiang;Hei Yue;Liu Weiping(department of Neurosurgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Brain Hospital,Xi'an People's Hospital(Xi'an Fourth Hospital),Xi'an 710100,China;Department of Oncology,Xijing Hospital,Air Force Medical University,Xi'an 7100321 China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第11期1119-1123,共5页
Chinese Journal of Neurosurgery
关键词
垂体肿瘤
自然腔道内镜手术
手术后并发症
垂体辨认和保护
Pituitary neoplasms
Natural orifice endoscopic surgery
Postoperative complications
Identification and preservation of the pituitary gland
