CAJ | 학술논문

目的初步探讨神经内镜下经鼻蝶窦入路垂体ACTH腺瘤切除术的手术技巧及并发症的预防.方法根据患者临床症状、地塞米松抑制试验、岩下窦采血、神经影像学等检查筛选出47例垂体ACTH腺瘤患者,对以上患者全部行单鼻孔经鼻蝶窦入路肿瘤切除术.结果肿瘤全切43例(91.5％),部分切除4例(8.5％).术后内分泌功能改善者44例(93.6％),未改善者3例(6.4％).术后出现并发症者6例(12.8％),其中垂体功能低下者3例,脑脊液鼻漏者2例,脑干梗死者1例.术后随访4～52个月,出现并发症者有3例明显改善,4例未全切者经影像学证实无复发.结论 ACTH腺瘤患者高血压、糖尿病等内科合并症多,微腺瘤比例高,解剖结构辨认难度大,且部分患者需行瘤周垂体部分切除术,术中鞍膈及蛛网膜破裂的可能性大,围手术期风险较高.神经内镜下经鼻蝶窦入路术野清晰,可在直视下切除病变、重建鞍底,可安全有效切除垂体ACTH腺瘤.
목적 초보탐토신경내경하경비접두입로수체ACTH선류절제술적수술기교급병발증적예방.방법 근거환자림상증상、지새미송억제시험、암하두채혈、신경영상학등검사사선출47례수체ACTH선류환자,대이상환자전부행단비공경비접두입로종류절제술.결과 종류전절43례(91.5％),부분절제4례(8.5％).술후내분비공능개선자44례(93.6％),미개선자3례(6.4％).술후출현병발증자6례(12.8％),기중수체공능저하자3례,뇌척액비루자2례,뇌간경사자1례.술후수방4～52개월,출현병발증자유3례명현개선,4례미전절자경영상학증실무복발.결론 ACTH선류환자고혈압、당뇨병등내과합병증다,미선류비례고,해부결구변인난도대,차부분환자수행류주수체부분절제술,술중안격급주망막파렬적가능성대,위수술기풍험교고.신경내경하경비접두입로술야청석,가재직시하절제병변、중건안저,가안전유효절제수체ACTH선류.
Objective To explore the surgical techniques and prevention of complications of endoscopic transphenoidal surgery (ETS) for pituitary adrenocorticotropic hormone (ACTH) adenoma.Methods Forty-seven patients with pituitary ACTH adenoma were selected in our department from examinations like high dose dexamethasone suppression test,bilateral inferior petrosal sinus sampling (BIPSS),neuroimaging examination and so on.Then ETS via single nostril was carried out in these patients.Results Total resection was achieved in 43 (91.5％) cases and partial in 4 (8.5％).After surgery,the endocrinal function was improved in 44 (93.6％) patients while 3 (16.4％) showed no obvious amelioration.The postoperative complications occurred in 6 patients (12.8％),including 3 cases of hypopituitarism,2 cerebrospinal fluid rhinorrhea,1 case of brain stem infarction.After the follow-up of 4-52 months,the complications were obviously improved in 3 patients.4 patients without total resection demonstrated no recurrence by enhanced pituitary MRI.Conclusions Patients with ACTH adenoma tended to have more internal medical complications like hypertension,diabetes,and so on.And the higher proportion of micro-adenoma in these patients made the identification of anatomical structures difficult.Besides,as some patients needed partial hypophysectomy,they might have a higher possibility of diaphragma sellae and arachnoid membrane rupture.On the whole,the risks during perioperative period for ACTH adenoma was greater than those of other kinds of adenomas.While ETS had a bright surgical field,and could make direct resection of the lesion and sellar floor reconstruction possible.As a result,ETS was a safe and effective method for the surgical treatment of pituitary ACTH adenoma.