摘要
目的：总结神经内镜下经鼻内蝶窦入路切除垂体腺瘤的经验及体会。方法：46例垂体腺瘤患者，男19例，女27例；年龄22～73岁，中位年龄39岁。MRI或CT检查，肿瘤直径〈1cm9例，1～2cm11例，2～3cm18例，〉3cm8例。功能性腺瘤35例，无功能性腺瘤11例。全部患者采用神经内镜下（不使用鼻窥器）经鼻内蝶窦入路肿瘤切除术。3例手术中使用神经导航系统辅助。结果：全切除肿瘤35例，次全切（〉80％）6例，大部切除5例；手术时间1～3．5h。手术后住院3～10d。无死亡，无视神经损伤并发症发生；随访1个月至3．3年，原有症状均有所改善，视力不同程度改善21／23例，异常增高的激素水平降至正常24／32例；2例手术后又接受了γ刀治疗，18例手术后3个月行普通放疗，1例MRI一年后复查有复发，而再次导航辅助下内镜手术。结论：内镜下手术具有手术创伤小、深部照明好、提供360。全景的术野、更靠近手术靶区、并发症更少等优点，从而使患者恢复快。
Objective：To introduce our experience on endoscopic endonasal transsphenoidal surgery in 46 patients with pituitary adenomas. Methods： Forty-six patients （27 females and 19 males） with a median age of 39 years （range 22-73 years） were enrolled in this study. MRI or CT images showed that the diameters of the tumor were 〈 1 cm in 9 patients, 1-2 cm in 11, 2- 3 cm in 18 and 〉 3 cm in 8. Thirty-five patients had hormone-secreting adenomas and 11 had non-secreting ones. All patients received endoscopic endonasal transsphenoidal （absence of the transsphenoidal retractor） resection of the tumors and neuronavigation system was used in 3 cases. Results： Total tumor resection was achieved in 35 patients, subtotal in 6 and partial in 5. The operative time was from 1 to 3.5 hours. The postoperative hospitalization time was averagely 4.6 days （from 3 days to 10 days） and there was no operative death or optic nerve injury in our group. During follow-up （1 month to 3.3 years）, 21 of the 23 patients with eyesight problems had their visual acuity improved and 24 of the 32 patients with abnormally high levels of hormones had their hormones restored to the normal levels. Two patients received y-knife surgery after operation and 18 cases received radiation therapy 3 months after operation. Recurrence was found in 1 patient with MRI 1 year later and received neuronavigation-assisted endoscopic reoperation again. Conclusion： The method in this paper, with less operative trauma and complication, provides a satisfactory deep illumination and a panoramic operative field; moreover, it brings us more close to the operative target. All these factors contribute to the rapid recovery of patients.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2006年第2期207-210,共4页
Academic Journal of Second Military Medical University
关键词
内镜
经蝶入路
垂体腺瘤
神经导航
endoscopy
transsphenoidal approach
pituitary tumor
neuronavigator
