论文部分内容阅读
目的:初步探讨经口鼻蝶入路内窥镜辅助显微神经外科手术切除垂体腺瘤的手术技巧和临床效果。方法:我院神经外科收住的6例临床诊断的垂体大腺瘤病人,3例生长激素型,2例泌乳素型,1例功能型。6例患者均行经口鼻蝶入路内窥镜辅助显微外科手术切除肿瘤。常规在显微镜下尽可能切除肿瘤,然后导入0°～70°神经内窥镜检查是否有肿瘤残留,若有残留内窥镜辅助后切除肿瘤。结果:5例患者单纯手术显微镜下未能全切肿瘤,内窥镜观察后肿瘤残留,内窥镜辅助后切除。1例术中渗血较多,内窥镜无法使用,手术时间延长50～120分钟,平均90分钟。术后6例发生短暂性尿崩,2例术中见脑脊液漏,其中1例术后未发生脑脊液漏,1例术后腰穿置管后不漏。4例术后第一日内分泌激素水平下降正常范围内;2例肢端肥大症不适症状明显缓解。结论:内窥镜辅助显微外科手术可能较好的弥补显微手术的缺点,可以更安全地全切肿瘤;但它延长了手术时间,增加了组织暴露。此技术的长期有效性需进一步观察。
Objective: To investigate the surgical technique and clinical effect of endoscopic assisted microsurgery for the removal of pituitary adenomas by transnasal orbital approach. Methods: Six cases of pituitary adenoma diagnosed by Department of Neurosurgery in our hospital, 3 cases of growth hormone type, 2 cases of prolactin type and 1 case of functional type. Six patients underwent endoscopic nasal endoscopic microsurgery for resection of the tumor. Conventional resection of the tumor as much as possible under the microscope, and then imported 0 ° ~ 70 ° neuroendoscopy for tumor residues, if residual endoscopic assisted resection of the tumor. Results: Five patients failed to complete resection of the tumor under a simple surgical microscope. The residual tumor was observed after endoscopy and assisted by endoscopic resection. One case of intraoperative bleeding more endoscopy can not be used, the operation time extended 50 to 120 minutes, an average of 90 minutes. Postoperative transient diastolic occlusion occurred in 6 cases and cerebrospinal fluid leakage in 2 cases. No leakage of cerebrospinal fluid was found in 1 case and no leakage in 1 case. In 4 cases, the level of endocrine hormone decreased within the normal range on the first day after operation. The symptoms of acromegaly were relieved in 2 cases. CONCLUSIONS: Endoscopic assisted microsurgery may better compensate for the disadvantages of microsurgery and allow for more complete tumor clearance; however, it prolongs the procedure and increases tissue exposure. The long-term effectiveness of this technology needs further observation.