神经内镜经蝶窦入路治疗垂体腺瘤疗效分析
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摘要
目的：探讨应用神经内镜治疗垂体腺瘤的适应症,禁忌症,手术方法、术前术后处理及疗效。探索神经内镜在经鼻蝶垂体腺瘤手术中的临床意义和应用前景。
方法：回顾性分析确诊为垂体腺瘤且资料齐全的,应用内镜手术切除垂体腺瘤患者病例,其中山西医科大学第一医院神经外科61例,长治医学院附属和济医院神经外科12例,查阅病例资料,并进行术后随访,对所得资料进行总结。总结项目包括肿瘤大小、肿瘤切除程度；术前、后PRL及GH激素值；甲状腺功能；临床症状指标；术后并发症包括鼻腔出血、尿崩症、鼻漏、感染及电解质紊乱,视力、视野改变等,术后住院时间及手术时间。
结果：73例患者,肿瘤全部切除47例,次全切除19例；大部分切除5例,部分切除2例；依据垂体腺瘤手术生物学指标疗效标准(Hardy)：治愈：34例；好转：16例；无效：7例。其它垂体功能测定：甲状腺功能,恢复或保持正常：49例；无变化：18例；恶化：6例。临床指标：治愈52例,好转35例,无效5例；并发症包括：尿崩症19例、鼻漏8例、颅内感染6例、鼻腔出血4例、视力、视野改变3例垂体功能低下6例及电解质紊乱14例；术后住院时间10.66±4.94天,手术时间2.43±1.41小时。无死亡病例。
结论：神经内镜下经蝶窦人路切除垂体腺瘤,具有手术创伤小、照明好、病人安全、舒适度好、恢复快,术野范围大,并发症少,操作时间短等优点,适用于大多数的垂体腺瘤。该术式值得进一步推荐应用。
The efficacy analysis of single-nostril transsphenoidal endoscopic pituitary adenoma surgery
Objective:To explore the indications, contraindications, surgery method, pro-operative, post-operative treatment and efficacy analysis using single-nostril transsphenooidal endoscopic pituitary adenoma surgery; the clinical significance and future perspective of neuroendoscopy in transsphenodial surgery for pituitary adenomas.
Methods:The integral clinical date with pituitary adenomas patients surgical treated from department of neurosurgery in the first affiliated hospital Shan Xi medical University, He Ji Affiliated hospital Chang Zhi medical college was analyses retrospectively. The detailed medical records of patients are accessed to and the postoperative follow-up is carried on. The comparing items include the following accepts:the tumor resection rate, the complications after the surgery, including diabetes insipidus, pituitary dysfunction, electrolyte disorders, cerebrospinal fluid rhinorrhea, intracranial infection and nasal hemorrhage. The postoperative length of staying in hospital, the recovery situation of endocrine of PRL and GH, time-length among the operative, clinic symptom improvement, the size of the tumor were analyses. We acquire the conclusion through the statistical analysis.
Results:Among this group of 73 cases, total tumor resection are in 47 cases, the subtotal tumor resection,19 cases; the greater tumor resection,5 cases; the part tumor resection,2 cases. The hormone level (according to the pituitary adenoma post-operative biology norm efficacy standard (Hardy)):Cure in 34 cases; improve: 16 cases; invalid:7 cases. The functions of thyroid:improve in 49 cases, no change in 18 cases, worsen 6 cases. Clinical symptoms improvement:cure in 52 cases; improve:35 cases; invalid 5 cases. The complications after the surgery include diabetes insipidus in 19 cases, pituitary dysfunction:6 cases; electrolyte disorders: 14 cases; cerebrospinal fluid rhinorrhea:8 cases; intracranial infection:6 cases; nasal hemorrhage:4 cases; vision decreased 3 cases. The average length of stay in hospital after surgery:10.66±4.94 days, time-length among the operative:2.43±1.41 hours. There was no death case in this group.
Conclusions:The endoscopical transsphenodial surgery for pituitary tumors has advantages as minimal invasiveness, clear exposure of operation field, relatively complete resection of tumor, easy to operate, safety for patients, less severe complications, and shorter hospitalization time. The clinical application of the neuroendoscopy for pituitary adenoma is worthy of recommending.
方法：回顾性分析确诊为垂体腺瘤且资料齐全的,应用内镜手术切除垂体腺瘤患者病例,其中山西医科大学第一医院神经外科61例,长治医学院附属和济医院神经外科12例,查阅病例资料,并进行术后随访,对所得资料进行总结。总结项目包括肿瘤大小、肿瘤切除程度；术前、后PRL及GH激素值；甲状腺功能；临床症状指标；术后并发症包括鼻腔出血、尿崩症、鼻漏、感染及电解质紊乱,视力、视野改变等,术后住院时间及手术时间。
结果：73例患者,肿瘤全部切除47例,次全切除19例；大部分切除5例,部分切除2例；依据垂体腺瘤手术生物学指标疗效标准(Hardy)：治愈：34例；好转：16例；无效：7例。其它垂体功能测定：甲状腺功能,恢复或保持正常：49例；无变化：18例；恶化：6例。临床指标：治愈52例,好转35例,无效5例；并发症包括：尿崩症19例、鼻漏8例、颅内感染6例、鼻腔出血4例、视力、视野改变3例垂体功能低下6例及电解质紊乱14例；术后住院时间10.66±4.94天,手术时间2.43±1.41小时。无死亡病例。
结论：神经内镜下经蝶窦人路切除垂体腺瘤,具有手术创伤小、照明好、病人安全、舒适度好、恢复快,术野范围大,并发症少,操作时间短等优点,适用于大多数的垂体腺瘤。该术式值得进一步推荐应用。
The efficacy analysis of single-nostril transsphenoidal endoscopic pituitary adenoma surgery
Objective:To explore the indications, contraindications, surgery method, pro-operative, post-operative treatment and efficacy analysis using single-nostril transsphenooidal endoscopic pituitary adenoma surgery; the clinical significance and future perspective of neuroendoscopy in transsphenodial surgery for pituitary adenomas.
Methods:The integral clinical date with pituitary adenomas patients surgical treated from department of neurosurgery in the first affiliated hospital Shan Xi medical University, He Ji Affiliated hospital Chang Zhi medical college was analyses retrospectively. The detailed medical records of patients are accessed to and the postoperative follow-up is carried on. The comparing items include the following accepts:the tumor resection rate, the complications after the surgery, including diabetes insipidus, pituitary dysfunction, electrolyte disorders, cerebrospinal fluid rhinorrhea, intracranial infection and nasal hemorrhage. The postoperative length of staying in hospital, the recovery situation of endocrine of PRL and GH, time-length among the operative, clinic symptom improvement, the size of the tumor were analyses. We acquire the conclusion through the statistical analysis.
Results:Among this group of 73 cases, total tumor resection are in 47 cases, the subtotal tumor resection,19 cases; the greater tumor resection,5 cases; the part tumor resection,2 cases. The hormone level (according to the pituitary adenoma post-operative biology norm efficacy standard (Hardy)):Cure in 34 cases; improve: 16 cases; invalid:7 cases. The functions of thyroid:improve in 49 cases, no change in 18 cases, worsen 6 cases. Clinical symptoms improvement:cure in 52 cases; improve:35 cases; invalid 5 cases. The complications after the surgery include diabetes insipidus in 19 cases, pituitary dysfunction:6 cases; electrolyte disorders: 14 cases; cerebrospinal fluid rhinorrhea:8 cases; intracranial infection:6 cases; nasal hemorrhage:4 cases; vision decreased 3 cases. The average length of stay in hospital after surgery:10.66±4.94 days, time-length among the operative:2.43±1.41 hours. There was no death case in this group.
Conclusions:The endoscopical transsphenodial surgery for pituitary tumors has advantages as minimal invasiveness, clear exposure of operation field, relatively complete resection of tumor, easy to operate, safety for patients, less severe complications, and shorter hospitalization time. The clinical application of the neuroendoscopy for pituitary adenoma is worthy of recommending.
引文
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[2]Ezzat S, Asa SL, Couldwel WT, et al. The prevalence of pituitary adenomas; a systematic review. Cancer,2004,101;61361-61369.
[3]惠国祯主编.垂体瘤.第一版.北京.人民军医出版社.2004,383.
[4]Yeh PJ, Chen JW. Pituitary tumors:surgical and medical management, J. Suer Oncol,1997,6:67-92.
[5]王任直,姚勇.垂体腺瘤的微创治疗.中国微侵袭神经外科杂志.2008,13(3)97-99.
[6]Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery [J]. Laryngoscope,1992,102(2):198—202.
[7]Cappabianca P, DE-Divitis E. Endoscopy and transsphenoidal surgery [J]. Neurosurgery,2004,54(5):1043-1050.
[8]Kabil M S, Eby J B, Shahinian H K. Fully endoscopic transnasal versus transscptal transphenoidal pituitary surgery [J]. Minim Invasive Neurosurg,2005,48(6):348—354.
[9]Gondim J, Pinherio I. Neuroendoscopic endonasal transseptal approach to the sellar region:study of 30 cases[J]. Arq Neuropsiquiatr,2001.59: 901—904.
[10]Dehdashti AR, Ganna A, karabatsou K. et al. Pure endoscopic edonasal approach for pituitary adenomas:early surgical results in 200 patients and comparison with previous microsurgical series [J]. Neurosurgery. 2008,62(5):1006-1015.
[11]Jho H D. Endoscopic transsphenoidal surgery[J]. JNeurooncol,2001, 54(2):187-195.
[12]KabilMS, EbyJB, Shahinian H K. Fully endoscopic transnasal versus transscptal transphenoidal pituitary surgery [J]. Minim Invasive Neurosurg,2005,48(6):348—354.
[13]惠国桢主编.垂体瘤[M].第一版.北京.人民军医出版社.2004,383.
[14]王涤宇,王海军,徐杰.蝶窦的应用解剖学研究.解剖学研究,2003,25：130-132
[15]DE-Divtiis E, Cavallo LM, Cappabianca P, etal. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar
tumors:part 2[J]. Neurosurgery,2007.60(1):46.59.
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