CAJ | 학술논문

目的分析导航辅助内镜下经鼻蝶窦垂体瘤切除术的疗效.方法回顾性分析自2010年4月至2011年12月采用内镜经鼻蝶窦垂体瘤切除术治疗的患者91例.男40例,女51例.首次手术75例,因残留或复发再次手术16例.年龄12～ 75岁,平均48.7岁.肿瘤最大径＜1cm11例,1～4cm 63例,＞4cm 17例.Knosp 0～2级57例,Knosp 3级19例,Knosp 4级15例.无功能腺瘤54例,功能性腺瘤37例.所有患者术中均使用神经导航辅助.术后行视力、神经影像及内分泌随访,随访时间3 ～21个月,平均10.2个月.结果肿瘤大体全切74例(81％,74/91),大部切除13例,部分切除4例.Knosp 0～2级腺瘤大体全切54例(95％,54/57),Knosp 3级腺瘤大体全切17例(90％,17/19),Knosp 4级腺瘤大体全切3例(20％,3/15).术后视力改善32例(87％,32/37),内分泌治愈21例(57％,21/37).术后电解质紊乱4例,脑脊液漏3例,甲状腺功能低下3例,尿量增多2例,一过性视力障碍、肾上腺皮质功能低下、颅内感染、蝶窦炎性反应、术区出血各1例.结论内镜下经鼻蝶窦垂体瘤切除术安全、有效,结合神经导航技术可进一步增加其安全性和有效性.
목적 분석도항보조내경하경비접두수체류절제술적료효.방법 회고성분석자2010년4월지2011년12월채용내경경비접두수체류절제술치료적환자91례.남40례,녀51례.수차수술75례,인잔류혹복발재차수술16례.년령12～ 75세,평균48.7세.종류최대경＜1cm11례,1～4cm 63례,＞4cm 17례.Knosp 0～2급57례,Knosp 3급19례,Knosp 4급15례.무공능선류54례,공능성선류37례.소유환자술중균사용신경도항보조.술후행시력、신경영상급내분비수방,수방시간3 ～21개월,평균10.2개월.결과 종류대체전절74례(81％,74/91),대부절제13례,부분절제4례.Knosp 0～2급선류대체전절54례(95％,54/57),Knosp 3급선류대체전절17례(90％,17/19),Knosp 4급선류대체전절3례(20％,3/15).술후시력개선32례(87％,32/37),내분비치유21례(57％,21/37).술후전해질문란4례,뇌척액루3례,갑상선공능저하3례,뇨량증다2례,일과성시력장애、신상선피질공능저하、로내감염、접두염성반응、술구출혈각1례.결론 내경하경비접두수체류절제술안전、유효,결합신경도항기술가진일보증가기안전성화유효성.
Objective To analyze the efficacy of neuronavigation-guided pure endoscopic endonasal transsphenoidal approach for the surgical removal of pituitary adenomas.Methods We retrospectively analyzed the clinical data of 91 patients who received pure endoscopic endonasal transsphenoidal surgery for pituitary adenomas between April 2010 and December 2011.There were 40 males and 51 females,75 primary tumors and 16 residual or recurrent tumors.Patients aged from 12 to 75 years (mean 48.7 years).In 11 cases,the tumor diameter were less than 1cm,63 cases were 1-4cm,and 17 cases were more than 4 cm.57 cases were Knosp 0-2,19 cases Knosp 3,and 15 cases Knosp 4.There were 54 nonfunctional adenomas and 37 functional adenomas.Neuronavigation was used in all patients.Neuro-ophthalmological,neuroimaging and endocrinological follow-up was performed between 3 and 21 months (mean 10.2 months) postoperatively.Results The tumor was gross totally removed in 74 cases (81％,74/91),subtotal removed in 13 cases,and partially removed in 4 cases.For Knosp 0-2 adenomas,the gross total removal was achieved in 54 cases (95％,54/57),Knosp 3 in 17 cases (90％,17/19),and Knosp 4 in 3 cases (20％,3/15).Postoperative visual acuity improved in 32 cases (87％,32/37),and endocrine remission was observed in 21 cases (57％,21/37).The postoperative complications included electrolyte disturbances in 4 cases,CSF leakage in 3 cases,hypothyroidism in 3 cases,and diabetes insipidus in 2 cases.Temporary visual impairment,hypoadrenocorticism,meningitis,sphenoid sinus inflammation,and sella turcica bleeding were found in 1 case respectively.Conclusions The pure endoscopic endonasal transsphenoidal approach for the surgical removal of pituitary adenoma is safe and effective.The safety and effectiveness can be further increased through the combination with neuronavigation.