摘要
目的探讨神经内镜经鼻颅咽管瘤切除手术中垂体柄保留与否对术后垂体功能的影响。方法回顾性分析2014年9月至2019年8月于复旦大学附属华山医院神经外科接受神经内镜经鼻颅咽管瘤切除手术的117例患者的临床资料,通过调阅手术记录、手术视频、术后行头颅MRI以明确垂体柄的保留情况。术中监测容量状态变化以评估围手术期的垂体后叶功能,术后对垂体前后叶各内分泌轴的功能进行随访。结果术中76.9%(90/117)的患者保留垂体柄。垂体柄未保留组(27例)的术中总尿量、每小时尿量,以及术后即刻血钠水平与垂体柄保留组(90例)的差异均无统计学意义(均P>0.05)。术后117例患者均获得随访,中位随访时间为11.0个月(5.5~23.5个月)。随访结果表明,垂体柄保留组术后的性腺轴功能减退[70.8%(51/72)对比95.2%(20/21),P=0.021]、垂体后叶功能减退[41.1%(37/90)对比74.1%(20/27),P=0.003]的发生率均低于垂体柄未保留组;两组术后肾上腺皮质轴功能减退[68.9%(62/90)对比81.5%(22/27),P=0.202]、甲状腺轴功能减退[70.0%(63/90)对比85.2%(23/27),P=0.117]发生率的差异均无统计学意义。对于术前垂体功能正常者,术中保留垂体柄可显著降低术后新发性腺轴功能减退、垂体后叶功能减退的发生比例(性腺轴功能减退:10/23对比4/4,P=0.038;垂体后叶功能减退:20/65对比10/15,P=0.010),而对术后新发肾上腺皮质轴及甲状腺轴功能减退的影响无统计学意义(均P>0.05)。对于术前已合并垂体功能低下者,两组垂体各内分泌轴功能减退发生率的差异均无统计学意义(均P>0.05)。结论神经内镜经鼻颅咽管瘤切除术中保留垂体柄有利于术后远期性腺轴功能、垂体后叶功能的保留。
Objective To investigate the effects of pituitary stalk preservation on pituitary endocrinological functions after endoscopic endonasal resection for craniopharyngiomas.Methods The clinical data of 117 patients with craniopharyngiomas who underwent endoscopic endonasal resection at the Department of Neurosurgery,Huashan Hospital,Fudan University from September 2014 to August 2019 were retrospectively analyzed.Intraoperative pituitary stalk preservation or sacrifice was determined by reviewing operative records,videos and postoperative MRI scans.Intraoperative monitoring of variations in volume status was performed for evaluation of perioperative endocrine function of posterior pituitary.Patients were followed up with a special focus on the postoperative functions of pituitary axes.Results The pituitary stalk was preserved in 76.9%(90/117)of all cases.Total urine output,hourly urine output and immediate postoperative serum sodium level in stalk sacrifice group(27 cases)were not significantly different from those in stalk preservation group(90 cases)(all P>0.05).All 117 patients were followed up with a median of 11.0 months(range:5.5-23.5 months).The endocrine outcomes were more favorable when the pituitary stalk was preserved regarding the rate of hypogonadism[70.8%(51/72)vs.95.2%(20/21),P=0.021]and posterior pituitary dysfunction[41.1%(37/90)vs.74.1%(20/27),P=0.003]than stalk sacrifice group.No significant differences were found regarding the rate of postoperative hypoadrenalism[68.9%(62/90)vs.81.5%(22/27),P=0.202]or hypothyroidism[70.0%(63/90)vs.85.2%(23/27),P=0.117].Compared with those in patients with stalk sacrifice,surgically induced new-onset hypogonadism(10/23 vs.4/4,P=0.038)and function loss of posterior pituitary(20/65 vs.10/15,P=0.010)were significantly lower in patients with stalk preservation.For patients who had preoperative hypopituitarism,there was no significant difference in the rates of function loss of all pituitary axes between patients with and those without stalk preservation(all P>0.05).Conclusion Pituitary stalk preservation is helpful for the preservation of function of hypothalamus pituitary-gonad axis and posterior pituitary.
作者
陈晓琛
钟雯琴
赖兰
陈政源
沈明
寿雪飞
叶红英
张朝云
王镛斐
马增翼
Chen Xiaochen;Zhong Wenqin;Lai Lan;Chen Zhengyuan;Shen Ming;Shou Xuefei;Ye Hongying;Zhang Zhaoyun;Wang Yongfei;Ma Zengyi(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai200040,China;Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery(2018RU008),Chinese Academy of Medical Sciences,Shanghai200040,China;Shanghai Pituitary Tumor Center,Shanghai 200040,China;Department of Endocrinology and Metabolism,Huashan Hospital,Fudan University,Shanghai200040,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2022年第10期995-1000,共6页
Chinese Journal of Neurosurgery
基金
中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-008)。
关键词
颅咽管瘤
自然腔道内镜手术
垂体柄保留
垂体功能减退
Craniopharyngioma
Natural orifice endoscopic surgery
Pituitary stalk preserva-tion
Hypopituitarism
作者简介
通信作者:马增翼,Email:zengyima@foxmail.com。
