神经内镜下经鼻蝶垂体腺瘤切除手术体会

2018-04-27江楠蔡丹辉黄敏东陈曼华黄嘉斌

中国实用医药 2018年11期

江楠蔡丹辉黄敏东陈曼华黄嘉斌

【摘要】目的总结神经内镜下经鼻蝶垂體腺瘤切除术的手术经验，以便更好的开展该项技术。方法 16例采用神经内镜下经鼻蝶垂体腺瘤切除术的垂体瘤患者，分析其手术情况及效果，总结该术式的经验体会。结果 16例手术病例中，肿瘤全切15例，全切率94%。全切的患者中， 2例生长激素腺瘤和2例泌乳素腺瘤术后随访，激素均降至正常。无脑脊液漏15例，出现脑脊液漏1例，保守治疗痊愈。无颅内感染病例。手术效果满意。结论经鼻蝶垂体腺瘤切除术对神经内镜技术和手术经验要求较高，该术式微创，手术全切率高，效果好，并发症少，是垂体腺瘤首选手术方式。

【关键词】神经内镜；垂体腺瘤；经鼻蝶入路；临床疗效

DOI：10.14163/j.cnki.11-5547/r.2018.11.017

【Abstract】 Objective To summarize the surgical experience of neuroendoscopic transsphenoidal pituitary adenoma resection， so as to develop this technique. Methods The surgical situation and effect of 16 pituitary adenoma patients treated with endoscopic transsphenoidal pituitary adenoma was analyzed， and the experience was summarized. Results Of the 16 surgical cases， 15 were completely resected and the total resection rate was 94%. Of the patients with totally resection there were 2 cases of growth hormone adenoma and 2 cases of prolactinoma were followed up， and the hormones were all reduced to normal. There were 15 cases of non-cerebrospinal fluid leaks， and 1 case of cerebrospinal fluid leakage. They were cured after conservative treatment. No case of intracranial infection， adn the effect of the operation is satisfactory. Conclusion Transsphenoidal pituitary adenoma resection requires higher neuroendoscopic techniques and surgical experience. The minimally invasive surgery contains high total resection rate， good effect and fewer complications. It is the first choice for pituitary adenomas.

【Key words】 Neuroendoscopy； Pituitary adenoma； Transsphenoidal； Clinical efficacy

垂体腺瘤是常见的中枢神经系统肿瘤，发病率居原发性中枢神经系统肿瘤的第三位，约占10%～15%[1]。经鼻蝶入路适合于绝大多数垂体腺瘤的手术切除。随着神经内镜技术、器械的不断发展，内镜下经鼻蝶垂体腺瘤切除术越来越成熟，已经成为垂体瘤手术的首选术式[2]。回顾性分析本院神经外科2016年6月～2017年6月采用神经内镜经鼻蝶入路切除垂体瘤共16例，总结经验体会，以更好的开展此项工作。现报告如下。