内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位的可行性
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摘要
目的分析内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位的可行性。方法选取2014年9月—2016年12月宿迁市第一人民医院收治的鞍区占位患者8例,均经颅脑磁共振成像(MRI)检查证实并经内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位,分析其治疗结果及并发症发生情况。结果 8例患者术后均立即复查颅脑CT,其中7例患者无术后出血,1例患者示鞍区高密度影,考虑术区渗血并填塞自体脂肪组织。8例患者术后3 d复查颅脑MRI,其中7例示肿瘤完全清除,1例有少量残留。8例患者术后均出现不同程度尿崩症,经口服醋酸去氨加压素后好转,无一例出现术后脑脊液鼻漏、颅内感染;随访半年无一例复发。结论内镜辅助显微镜下扩大经鼻蝶入路切除鞍区占位安全可行,对肿瘤清除效果好且并发症较少。
Objective To analyze the feasibility of endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection. Methods A total of 8 patients with sellar region occupation lesions were selected in First People's Hospital of Suqian from September 20104 to December 2016,all of them were confirmed by craniocerebral MRI and received endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection,the therapeutic outcome and incidence of complications were analyzed.Results All of the 8 patients received craniocerebral CT reexamination immediately after operation,thereinto 7 cases did not occurred postoperative bleeding,1 case found high density shadow in sellar region,which was considered as errhysis of operating zone and packed with fat autograft. All of the 8 patients received craniocerebral MRI 3 days after operation,thereinto 7 cases got complete removal of tumor,1 case with little residual tumor. All of the 8 patients occurred different extent diabetes insipidus,and they take a turn for the better after taking desmopressin acetate orally,no one of them occurred cerebrospinal fluid rhinorrheaor intracranial infection,and no one occurred during the 6-month follow-up. Conclusion Endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection is safe and feasible,has good tumor removal effect and low risk of complications.
Objective To analyze the feasibility of endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection. Methods A total of 8 patients with sellar region occupation lesions were selected in First People's Hospital of Suqian from September 20104 to December 2016,all of them were confirmed by craniocerebral MRI and received endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection,the therapeutic outcome and incidence of complications were analyzed.Results All of the 8 patients received craniocerebral CT reexamination immediately after operation,thereinto 7 cases did not occurred postoperative bleeding,1 case found high density shadow in sellar region,which was considered as errhysis of operating zone and packed with fat autograft. All of the 8 patients received craniocerebral MRI 3 days after operation,thereinto 7 cases got complete removal of tumor,1 case with little residual tumor. All of the 8 patients occurred different extent diabetes insipidus,and they take a turn for the better after taking desmopressin acetate orally,no one of them occurred cerebrospinal fluid rhinorrheaor intracranial infection,and no one occurred during the 6-month follow-up. Conclusion Endoscope-assisted microscope guided expanding endonasal transsphenoidal approach for sellar region occupation lesions resection is safe and feasible,has good tumor removal effect and low risk of complications.
引文
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[2]杨鑫,甄海宁.经鼻蝶窦入路手术的应用和进展[J].中华神经外科疾病研究杂志,2014,13(2):184-186.
[3]徐成伟.鞍区显微手术入路的研究进展[J].中国临床神经外科杂志,2011,16(2):119-122.DOI:10.3969/j.issn.1009-153X.2011.02.023.
[4]SHIRANE R,CHING-CHAN S,KUSAKA Y,et al.Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern:an evaluation of the frontobasal interhemispheric approach[J].J Neurosurg,2002,96(4):704-712.DOI:10.3171/jns.2002.96.4.0704.
[5]TPEREIRA A M,BIERMASZ N R.reatment of nonfunctioning pituitary adenomas:what were the contributions of the last 10 years?A critical view[J].Ann Endocrinol(Paris),2012,73(2):111-116.DOI:10.1016/j.ando.2012.04.002.
[6]KOMOTAR R J,STARKE R M,RAPER D M,et al.Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas[J].Pituitary,2012,15(2):150-159.DOI:10.1007/s11102-011-0359-3.
[7]廖建春.扩大经鼻蝶入路蝶鞍区病变手术的解剖与临床[J].中华解剖与临床杂志,2015,20(4):370-373.DOI:10.3760/cma.j.issn.2095-7041.2015.04.024.
[8]赵澎,宋明,裴傲,等.神经内镜在颅底中线区域手术中的应用[J].中华神经外科杂志,2006,22(9):579-580.DOI:10.3760/j.issn:1001-2346.2006.09.029.