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神经内镜经鼻蝶入路垂体瘤切除术的临床疗效和并发症分析 被引量:32

Outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries
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摘要 目的 探讨神经内镜经鼻蝶入路垂体瘤切除术的临床疗效及并发症. 方法 深圳大学第一附属医院神经外科自2010年6月至2014年7月应用神经内镜经鼻蝶入路治疗垂体瘤患者111例(113次手术),回顾性分析患者的临床资料,统计不同Knosp分级肿瘤的切除率、临床治愈率及并发症. 结果 Knosp分级0~4级垂体瘤完全切除率分别为97.4%、85.7%、88.7%、51.9%、0%,比较差异有统计学意义(P<0.05),其中Knosp 3,4级垂体瘤的完全切除率明显低于Knosp 0、1、2级垂体瘤,差异有统计学意义(P<0.05);不同Knosp分级泌乳素腺瘤的临床治愈率比较差异有统计学意义(P<0.05),其中Knosp 0级泌乳素腺瘤的临床治愈率明显高于Knosp 1~4级肿瘤,差异有统计学意义(P<0.05);不同Knosp分级生长激素腺瘤、促肾上腺皮质激素腺瘤、混合性腺瘤的临床治愈率,无功能腺瘤的症状改善率比较差异均无统计学意义(P>0.05);术后严重并发症包括脑脊液鼻漏3例(2.7%)(其中2例伴颅内感染)、颅内出血4例(3.5%)(其中死亡1例)、颈内动脉损伤1例(0.9%).轻度并发症包括鼻出血3例(2.7%)、一过性尿崩14例(12.4%)、永久性尿崩1例(0.9%)、低钠血症3例(2.7%). 结论 神经内镜具有视野开阔、组织结构显示清楚等优点,有助于提高肿瘤切除率,特别是对处理侵犯海绵窦的垂体瘤有一定的优势.然而对Knosp分级≥Ⅲ级的肿瘤不应过分追求全切,否则出现严重术后并发症几率明显升高,术后密切观察随访和相应辅助治疗是提高疗效的要素. Objective To explore the outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries.Methods A retrospective review of clinical and radiographic data of 111 patients (113 procedures),admitted to our hospital from June 2010 to July 2014,was performed.The resection rate,clinical cured rate and complications in pituitary neoplasms of different Knosp classifications were compared.Results Gross total resection (GTR) rate for pituitary neoplasms according to Knosp classification was 97.4% in grade 0,85.7% in grade 1,88.7% in grade 2,51.9% in grade 3 and 0% in grade 4,with significant differences (P〈0.05);GTR rate in pituitary neoplasms of grade 3 and 4 was significantly lower than that in pituitary neoplasms of grade 1 and 2 (P〈0.05).Clinical cured rate of the prolactin adenomas of different Knosp grades was significantly different,and that of grade 0 was statistically higher than that of grade 1-4 (P〈0.05).Clinical cured rate of growth hormone adenoma,adeno-corticotrophic stimulating hormone adenoma and mixed-functional adenomas of different grades showed no significant differences (P〉0.05).Chief complaints were improved in 75.0%-91.7% non-functioning adenomas.Postoperative severe complications included 3 patients (2.7%) with cerebrospinal fluid rhinorrhea,4 (3.5%) intracranial hematoma,1 (0.9%);postoperative mild complications included 3 (2.7%) epistaxis,14 (12.4%) transient diabete insipidus,1 (0.9%) permanent diabetes insipidus and 3 (2.7%) hyponatremia.Mortality was observed in one patient with intracranial hematoma.Conclusions Neurendoscope provides a superior view of the sellar region,and improves the extent of resection of pituitary adenoma especially for those with cavernous sinus invasion;however,blind pursuit of GTR for tumor with Knosp classification greater than grade 3 will increase the risk of severe complications.Safety should always be the priority for a procedure with a long le
作者 郑文键 李维平 纪涛 张协军 高永中 黄国栋 Zheng Wenjian, Li Weiping, Ji Tao, Zhang Xiejun, Gao Yongzhong, Huang Guodong(Deportment of Clinical Medicine, Medical College, Shontou University, Shantou 515041, China)
出处 《中华神经医学杂志》 CAS CSCD 北大核心 2015年第6期609-613,共5页 Chinese Journal of Neuromedicine
基金 深圳市科技创新委员会课题(ZDSYS20140509173142601)
关键词 神经内镜 垂体腺瘤 临床疗效 术后并发症 Neuroendoscope Pituitary neoplasm Treatment outcome Postoperative complication
作者简介 郑文键为在读硕士研究生 通信作者:黄国栋.Email:jxgd211@163.com
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