神经内镜经鼻蝶垂体腺瘤手术42例临床分析

发布时间：2018-04-29 07:28

本文选题：神经内镜 + 垂体腺瘤　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:探讨神经内镜下经鼻蝶入路手术治疗垂体腺瘤的技巧并观察临床效果。方法:总结我院2015年6月至2016年12月同一手术者开展的神经内镜经鼻蝶入路治疗垂体腺瘤42例,术前患者均行垂体MRI平扫+增强、副鼻窦CT及相关激素检验,采用全麻下神经内镜经鼻蝶入路切除肿瘤,双人四手操作,术中根据肿瘤情况取带血管蒂鼻中隔粘膜瓣,肿瘤切除后行严密的鞍底重建。术中无脑脊液漏者术后三天拔出鼻腔纱条,常规抗生素使用一周。术中若发生脑脊液漏者用14号导尿管球囊压迫一周,2周拔出鼻腔纱条,同时使用第三代头孢预防感染12天,术后随访6-12月,复查垂体MRI及激素水平。结果:42例患者中肿瘤全切37例,1例混合性腺瘤及2例质地较韧的肿瘤部分残留,2例侵袭型垂体腺瘤少量残留。19例功能性垂体腺瘤激素水平恢复正常,11例患者出现尿崩,9例经治疗后治愈,2例明显好转。术前垂体功能正常患者术后无一例出现垂体功能低下,术前4例垂体功能低下患者术后口服药物替代治疗,2月后复查垂体功能恢复满意并予以停用,本组1例巨大腺瘤合并梗阻性脑积水患者术后出现术区血肿并脑积水加重,行神经内镜下透明膈造瘘后顺利康复;术后蝶窦炎2例,无嗅觉障碍及鼻腔不适。术后出现脑脊液鼻漏4例,予抬高头位、腰大池引流7-14天后脑脊液漏完全消失。结论:神经内镜经鼻蝶入路手术治疗垂体腺瘤暴露肿瘤满意,对正常垂体及垂体柄保护好,手术安全有效,可在直视下最大范围、更安全地切除垂体腺瘤,术后并发症少,效果满意。
[Abstract]:Objective: to investigate the technique of endoscopic transsphenoidal approach in the treatment of pituitary adenoma. Methods: from June 2015 to December 2016, 42 patients with pituitary adenoma underwent endoscopic transnasal transsphenoidal approach in our hospital. All patients were performed MRI enhancement, paranasal sinus CT and related hormone examination before operation. Under general anesthesia, the tumor was resected by endoscopic transnasal transsphenoidal approach with double hands. The vascularized nasal septum mucosa flap was obtained according to the tumor condition, and the Sellar floor reconstruction was performed after resection of the tumor. Nasal gauze was drawn 3 days after operation without cerebrospinal fluid leakage. Routine antibiotics were used for one week. In the case of cerebrospinal fluid leakage, nasal gauze was pulled out with 14 catheter balloon for 2 weeks and the third generation cephalosporium was used to prevent infection for 12 days. The postoperative follow-up was 6 to 12 months, and the pituitary MRI and hormone levels were reexamined. Results among 42 patients, 37 cases had tumor resection, 1 case had mixed adenoma and 2 cases had partial residual tumor. 19 cases of functional pituitary adenoma returned to normal in 11 cases. 9 cases of urinal collapse were cured after treatment, 2 cases were improved obviously. There was no postoperative hypophysis in patients with normal pituitary function before and after operation. 4 patients with hypophysis were treated with oral drug replacement therapy. After 2 months, the pituitary function recovered satisfactorily and was stopped. One patient with giant adenoma complicated with obstructive hydrocephalus had postoperative hematoma and aggravation of hydrocephalus and recovered smoothly after endoscopic hyaline phrenostomy 2 cases of sphenoid sinusitis without olfactory disturbance and nasal discomfort. Cerebrospinal fluid rhinorrhea occurred in 4 cases after operation. The cerebrospinal fluid leakage disappeared completely after 7-14 days of lumbar cistern drainage. Conclusion: endoscopic transsphenoidal approach is satisfactory in the treatment of pituitary adenomas exposed to tumors, and is safe and effective for the normal pituitary gland and pituitary stalk. It is safe and safe to remove pituitary adenomas under direct vision, with less postoperative complications. The effect is satisfactory.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

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